Wellness Wednesday. Today we honor the people who served. Honoring them includes telling the truth about what service can leave behind. For some veterans, alcohol or drugs become a way to carry it. This post explains how PTSD and moral injury connect to substance use, what helps, and where to find support.
Why Service and Substance Use Can Connect
Combat and military trauma can leave the nervous system on high alert. Substances can quiet that for a short time, which is why they feel like relief. Our post on the research linking trauma and addiction explains that pattern in more detail.
The numbers show how often the two overlap. According to the 2023 National Survey on Drug Use and Health, 2.8 million veterans, or 14 percent, reported at least one substance use disorder in the past year. The Get Smart About Drugs site, citing the VA, reports that about 1 in 3 veterans treated for substance use disorder also has PTSD.
What Moral Injury Is
Moral injury is a different kind of wound. The VA National Center for PTSD describes the distressing psychological, behavioral, social, and sometimes spiritual effects of an event that goes against a person’s deeply held values. A person may take part in that event, fail to prevent it, or witness it. Moral injury is not a diagnosis, and it often occurs alongside PTSD.
The National Center lists some examples. One is taking part in military actions where civilians were hurt. Another is watching a fellow service member get hurt or killed and being unable to prevent it. Others include being unable to help people who were suffering and feeling responsible for harm an institution caused.
Guilt, shame, betrayal, and anger are the hallmark reactions. Guilt says, “I did something bad.” Shame says, “I am bad because of what I did.” Many people with moral injury also cannot forgive themselves.
Moral injury can change daily choices. The VA notes that a person may end a relationship because they do not feel worthy of love. They may skip therapy because they feel too ashamed or do not believe they deserve to feel better. For some veterans, those feelings also lead to alcohol and drug use.
How PTSD and Moral Injury Differ
The two share features, including guilt, shame, and loss of trust. They also differ. According to the National Center for PTSD, people with PTSD often feel they must stay on high alert, which is not usually a feature of moral injury. A person can have either one without the other. When both are present, symptoms may be more severe.
What the Research Shows
A study of 1,321 combat veterans from a nationally representative survey linked exposure to morally injurious events with substance use disorders. Different types of events tied to different patterns of alcohol and drug use. The authors argue that clinicians should ask about these experiences when they assess and plan care. Because this was survey data, it shows a link, not a cause.
The field is still young. The National Center for PTSD says the study of moral injury is new and that researchers are still learning how to help.
What Helps
Treatment exists. The National Center says PTSD treatment can reduce some distress, including guilt and shame. Its provider guidance notes that prolonged exposure and cognitive processing therapy can both target core parts of moral injury. Cognitive processing therapy works on beliefs such as “I am unforgivable.” Our post on prolonged exposure therapy covers how treating PTSD and substance use together can work.
A 2022 review describes a six session therapy built for trauma related guilt. In a randomized trial of 144 post 9/11 veterans, it reduced guilt, PTSD symptoms, and depression symptoms more than supportive care.
Connection matters too. The VA says talking with others who have had similar experiences can support healing, even though shame makes many veterans hesitate to open up. WisHope Recovery offers trauma informed care, EMDR, and Brainspotting alongside substance use treatment.
Where to Find Support
Veterans Crisis Line. Dial 988, then press 1. You can also text 838255 or chat online at veteranscrisisline.net. It is free and available 24/7, and many responders are veterans themselves. Families and friends can use it too. If someone is in immediate danger, call 911.
VA substance use care. The VA offers medications, including medically managed detox and medicines that reduce cravings. It also offers outpatient counseling, intensive outpatient treatment, self help groups, and residential care. Special programs serve women veterans, returning combat veterans, and homeless veterans. The VA also treats PTSD and depression.
To start, apply for VA health care and tell your VA primary care provider about your substance use. You can also use the VA’s substance use disorder program locator, call the VA information line at 800.827.1000, or contact your local VA medical center. Veterans of Iraq and Afghanistan can ask for the OEF, OIF, and OND coordinator.
Vet Centers. Combat zone veterans can get free, private counseling and assessments at Vet Centers, even without VA benefits.
Homeless veterans. The National Call Center for Homeless Veterans answers 24/7 at 877.424.3838.
Community treatment. The SAMHSA National Helpline offers free, confidential treatment referrals around the clock at 800.662.4357.
The Bottom Line
If substance use is part of how you carry what you saw or did, you are not alone. Treatment can address the use and the weight underneath it.
If you want to talk through options, learn about our treatment programs or complete our online assessment form. Our admissions team can help you find the right fit.