Moral Injury, Substance Use, and Posttraumatic Stress Disorder Symptoms Among Military Personnel: An Examination of Trait Mindfulness as a Moderator
Open accessAbstract
Mindfulness‐based approaches have been suggested as possible methods to treat moral injury in military personnel. However, empirical research has yet to evaluate if mindfulness acts as a protective factor for the possible negative effects of moral injury, such as alcohol use, drug use, or posttraumatic stress disorder (PTSD) symptoms. In this study, we investigated if five facets of mindfulness (i.e., observing, nonjudging, nonreactivity, awareness, and describing) moderated associations between moral injury and the outcomes of PTSD symptoms, alcohol misuse, and drug abuse symptoms in a sample of military personnel. Participants were 244 military personnel (the majority were former military members) who had been deployed at least once during the Iraq War, War in Afghanistan, other wars, or humanitarian missions. The study results indicated that nonjudging, β = −.22, and awareness, β = −.25, had significant attenuating effects on the association between moral injury and drug abuse symptoms. However, observing, β = .17; nonreactivity, β = .23; and describing, β = .15, had significant synergistic effects (i.e., they strengthened the association between moral injury and drug abuse symptoms). There were no significant moderation effects on the associations between moral injury and PTSD symptoms or between moral injury and alcohol misuse. Our results provide initial evidence that not all facets of mindfulness may protect against the challenges of coping with moral injury. Directions for future research and implications for practice are discussed.
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MM can help reduce alcohol and drug abuse among veterans with PTSD.
“Moreover, MM can help reduce alcohol and drug abuse among veterans with PTSD.56”
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SAUNDERS, J. B., AASLAND, O. G., BABOR, T. F., DE LA FUENTE, J. R., & GRANT, M. (1993) · Addiction · doi:10.1111/j.1360-0443.1993.tb02093.x · Cited by 13,482 · see citing works
Using Self-Report Assessment Methods to Explore Facets of Mindfulness
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006) · Assessment · doi:10.1177/1073191105283504 · Cited by 7,511 · cited 3× · see citing works
“, smells) and bodily sensations rather than cognition and emotion, like the other facets (Baer et al., 2006).”
BackgroundInfluentialThe Self-Medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications
Khantzian, E. J. (1997) · Harvard Review of Psychiatry · doi:10.3109/10673229709030550 · Cited by 3,242 · cited 1× · see citing works
“Although nonreactivity may be adaptive in combat situations and encouraged in training, it is possible that nonreactivity may be associated with the use of drugs to assuage emotional pain (Khantzian, 1997).”
BackgroundMoral injury and moral repair in war veterans: A preliminary model and intervention strategy
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.07.003 · Cited by 2,738 · see citing works
Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT
Lindsay, E. K., & Creswell, J. D. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.10.011 · Cited by 919 · see citing works
A comprehensive review of the psychometric properties of the Drug Abuse Screening Test
Yudko, E., Lozhkina, O., & Fouts, A. (2007) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2006.08.002 · Cited by 906 · see citing works
Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma
Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011) · Trauma, Violence, & Abuse · doi:10.1177/1524838011416375 · Cited by 387 · see citing works
Defining and assessing moral injury: A syndrome perspective
Jinkerson, J. D. (2016) · Traumatology · doi:10.1037/trm0000069 · Cited by 381 · see citing works
Risk for alcoholism and individual differences in the stress-response-dampening effect of alcohol
Sher, K. J., & Levenson, R. W. (1982) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.91.5.350 · Cited by 344 · see citing works
Soysa, C. K., & Wilcomb, C. J. (2015) · Mindfulness · doi:10.1007/s12671-013-0247-1 · Cited by 291 · see citing works
A functional approach to understanding and treating military-related moral injury
Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.07.003 · Cited by 226 · see citing works
Breslin, F. C., Zack, M., & McMain, S. (2002) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.9.3.275 · Cited by 215 · see citing works
A meta-analysis of the relationship between trait mindfulness and substance use behaviors
Karyadi, K. A., VanderVeen, J. D., & Cyders, M. A. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2014.07.014 · Cited by 158 · see citing works
Vujanovic, A. A., Youngwirth, N. E., Johnson, K. A., & Zvolensky, M. J. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.08.005 · Cited by 137 · see citing works
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Shen, H., Chen, M., & Cui, D. (2020) · General Psychiatry · doi:10.1136/gpsych-2020-100214 · Cited by 44 · see citing works
McDaniel, J. T., Redner, R., Jayawardene, W., Haun, J., Clapp, J., Che, D., Renzaglia, K., & Abou-Jabal, D. (2023) · Journal of Religion and Health · doi:10.1007/s10943-023-01905-5 · Cited by 23 · see citing works
Bernstein, A., Aizik-Reebs, A., Phung, Y., Yuval, K., Gebremariam, S. G., & Vujanovic, A. A. (2026) · Clinical Psychological Science · doi:10.1177/21677026251344148 · Cited by 14 · see citing works
Kelley, M. L., Strowger, M., Chentsova, V. O., Bravo, A. J., Gaylord, S. A., Burgin, E. E., Vinci, C., Ayers, K. L., & Agha, E. (2022) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2022.101011 · Cited by 7 · see citing works
Self-citationKelley, M. L., Bravo, A. J., Burgin, E. E., Gaylord, S. A., Vinci, C., Strowger, M., Gabelmann, J. M., & Currier, J. M. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.23778 · Cited by 5 · see citing works
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- Authors
- Davies, R. L., Prince, M. A., Bravo, A. J., Kelley, M. L., & Crain, T. L.
- Affiliations
- Colorado State University (US)
- University of New Mexico (US)
- Old Dominion University (US)
- Corresponding author
- Davies, Rachel L.
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2019-05-29
- Volume
- 32
- Issue
- 3
- Pages
- 414-423
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- PMC
- PMC6581602
- OpenAlex
- W2947417026
- Cited by
- 26
- References
- 14
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 3
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Traumatic Stress (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (T32‐AA018108)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Keywords
- moral injury, trait mindfulness, mindfulness facets, post-traumatic stress disorder, alcohol abuse, drug abuse, military personnel, war veterans, Iraq War, Afghanistan War, non-judgment, awareness, moderating effect, substance use
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Male, Military Personnel, Morals, Stress Disorders, Post-Traumatic, Substance-Related Disorders, Spirituality, Self Report, Mindfulness
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