Members of the military face an elevated risk of developing a substance use disorder (SUD). Soldiers, airmen, marines, and sailors are often exposed to particular stresses unfamiliar to civilians. Multiple deployments, witnessing extreme violence, combat exposure, and related injuries can function as powerful stressors, increasing the risk of self-medication with drugs and alcohol. Like their civilian counterparts, they may become addicted because of inappropriate attempts at controlling their emotional pain.
In addition, the workplace culture among military personnel can make it more difficult for people with SUDs to seek treatment. Many women and men in uniform still view problematic substance use and mental health issues as signs of weakness, fearing negative consequences if they are open about them because of the stigma attached to SUD and mental health problems.
A psychological stressor particular to members of the military and first responders is “moral injury.” It can be defined as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” (Litz, et al., 2009)
In her article “Returning to Life: Understanding How Moral Injury Impacts Veterans,” Dr. Rita Nakashima Brock, the director of the Shay Moral Injury Center at Volunteers of America wrote:
“Moral injury is an affliction of moral conscience, a negative judgment we pass on ourselves in response to violating our core moral values or being contaminated by exposure to evil. It can lead us to feel unforgivable for something we did, failed to do, witnessed, or endured, and it can cause us to conclude we are no longer good and decent persons. Such judgments fuel a host of moral emotions, such as guilt, shame, grief, remorse, disgust, and outrage; and when we lose meaning or faith, we also lose our ability to trust our world, others, and even ourselves. We become divided against ourselves.”
“Service members are confronted with numerous moral and ethical challenges in war,” wrote Brett Litz, Nathan Stein, et al. in their 2009 study “Moral injury and moral repair in war veterans.” “They may act in ways that transgress deeply held moral beliefs or they may experience conflict about the unethical behaviors of others. Warriors may also bear witness to intense human suffering and cruelty that shakes their core beliefs about humanity.”
Such moral injury may be the result of traumatic loss on the battlefield, causing feelings of guilt related to the loss of a comrade. “Losing a friend in battle is like losing a soul mate—the deep love of a lifetime—and the losses of war are riddled with intense grief and, often, with survivor guilt,” wrote Dr. Brock. “However, what even military veterans do not consider is that such bonds can render ordinary civilian relationships untrustworthy, transactional, and shallow by comparison.”
The moral injury may be self-directed—a sense of guilt and shame related to the service member’s own actions. Or other-directed— a sense of anger and betrayal related to the actions of others that had a strong impact on the service member.
“For veterans with moral injury, the shift back to civilian society and values can become impossible because their moral conscience traps them in solitary mistrust and self-punishing agony. They may have lost their best friends in their unit or feel ashamed of things they did or failed to stop. They can feel so hollowed out, numb, and despairing that they cannot find their way back from emotional isolation and end up living painfully dislocated from ordinary life and relationships,” explained Brock. “They can be angry with their government, military authorities, even God.”
Such anger and despair can have serious consequences if service members are “unable to contextualize or justify their actions or the actions of others and are unable to successfully accommodate various morally challenging experiences into their knowledge about themselves and the world.” (Litz, et al., 2009)
Many will attempt to seek relief by misusing drugs and alcohol. This maladaptive coping mechanism does not help process a moral injury or any other trauma the individual may have suffered. The substance misuse only covers up the trauma and only for a short while before it may become a serious problem itself. “Moral injury in service members and veterans appears to be a distinct phenomenon warranting its own line of inquiry and development of special intervention strategies,” Litz, Stein, et al. concluded in “Moral injury and moral repair in war veterans.”
Members of the military who develop a substance use disorder as a result of their particular mental health issues require treatment that addresses all underlying issues to be successful. After serving their country, they deserve to be treated by specialists who understand their particular psychological needs, professional environment, and workplace culture. If moral injury is part of the problem, moral repair needs to be part of the answer.
The Farley Center at Williamsburg Place proudly helps our men and women in uniform who struggle with substance use disorders. Members of the US military who develop health problems can rely on a healthcare program known as TRICARE. Farley has a lot of experience working with the command structure and healthcare provisions of the US military. A significant percentage of Farley patients have TRICARE coverage. That is quite different from many other addiction treatment centers that don’t take TRICARE at all or are unable to handle TRICARE cases directly—mostly because they are unfamiliar with the provisions of the program.
If you or someone you know is struggling with substance use and could benefit from addiction treatment services, please contact The Farley Center at 800.582.6066 or fill out our admissions request form.