nach oben

Current Treatment Options in Psychiatry

Erschienen in:

01.12.2022 | Moral Injury (JI Harris, Section Editor)

Moral Injury in the Context of Substance Use Disorders: a Narrative Review

verfasst von: Jessica Van Denend, PhD, J. Irene Harris, PhD, Brian Fuehrlein, MD, Ellen L. Edens, MD, MPE

Erschienen in: Current Treatment Options in Psychiatry | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Opinion statement

The rate of annual drug overdose deaths in the USA recently topped 100,000 (CDC/National Center for Health Statistics 2021), an illustration of the critical need to prevent and treat substance use disorders (SUDs). As a complex, chronic medical condition, substance use treatment requires psychological, emotional, and spiritual interventions along with medical care. The recently developed concept of moral injury has been increasingly studied and applied to military service members who experience conflict between the expectations or survival needs of combat and their moral values. This review explores whether moral injury, along with the related emotional, psychological, and spiritual symptoms, can also develop in the context of SUDs. This review identified 5 manuscripts related to moral injury arising in a substance use context. These studies were small in sample size and qualitative in nature but did indicate the presence of moral injury within the context of substance use. Further studies are needed to better understand and treat moral injury related to SUDs. A conceptualization of how moral injury may arise in the context of substance use is presented here. It is suggested that the activation of the primitive dopaminergic reward system causes a potential conflict between the experienced need for the addictive substance and a person’s moral code or values. The moral injury resulting from this collision may impact treatment and recovery.

Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, et al. Moral injury and moral repair in war Veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009;29(8):695–706. https://doi.org/10.1016/j.cpr.2009.07.003.CrossRefPubMed

Shay J. Casualties Daedalus. 2011;140(3):179–88. https://doi.org/10.1162/daed_a_00107.CrossRefPubMed

Drescher KD, Foy DW, Kelly C, Leshner A, Schutz K, Litz B. An exploration of the viability and usefulness of the construct of moral injury in war Veterans. Traumatology. 2011;17(1):8–13. https://doi.org/10.1177/1534765610395615.CrossRef

Brock RN, Lettini G. Soul repair: recovering from moral injury after war. Boston, MA: Beacon Press; 2012.

5.•

Griffin BJ, Purcell N, Burkman K, Litz BT, Bryan CJ, Schmitz M, et al. Moral injury: an integrative review. J Trauma Stress. 2019;32(3):350–62. https://doi.org/10.1002/jts.22362. A good review of epidemiological and clinical studies, including limitations of the literatureCrossRefPubMed

Tracy DK, Tarn M, Eldridge R, Cooke J, Calder JDF, Greenberg N. What should be done to support the mental health of healthcare staff treating COVID-19 patients? Br J Psychiatry. 2020;217(4):537–43. https://doi.org/10.1192/bjp.2020.109.CrossRefPubMed

Sugrue EP. Moral injury among professionals in K-12 education. Am Educ Res J. 2020;57(1):43. https://doi.org/10.3102/0002831219848690.CrossRef

Levinson M. Moral injury and the ethics of educational injustice. Harvard Educ Rev. 2015;85(2):203–28. https://doi.org/10.17763/0017-8055.85.2.203.CrossRef

Papazoglou K, Blumberg DM, Chiongbian VB, Tuttle BM, Kamkar K, Chopko B, et al. The role of moral injury in PTSD among law enforcement officers: a brief report. Frontiers in Psychology. 2020;11. https://doi.org/10.3389/fpsyg.2020.00310

10.

Papazoglou K, Blumberg DM, Kamkar K, McIntyre-Smith A, Koskelainen M. Addressing moral suffering in police work: theoretical conceptualization and counseling implications. Canadian Journal of Counselling and Psychotherapy. 2020;54(1)

11.

Nickerson A, Schnyder U, Bryant RA, Schick M, Mueller J, Morina N. Moral injury in traumatized refugees. Psychother Psychosom. 2015;84(2):122–3. https://doi.org/10.1159/000369353.CrossRefPubMed

12.

Nickerson A, Byrow Y, Hoffman J, O’Donnell M, Bryant RA, Mastrogiovanni N, et al. The longitudinal association between moral injury appraisals and psychological outcomes in refugees. Psychological Medicine. 2020:1–13. https://doi.org/10.1017/S0033291720004262

13.

Hoffman J, Liddell B, Bryant RA, Nickerson A. The relationship between moral injury appraisals, trauma exposure, and mental health in refugees. Depress Anxiety. 2018;35(11):1030–9. https://doi.org/10.1002/da.22787.CrossRefPubMed

14.

West Virginia Public Defender Services. Virtual training: law, vicarious trauma, and moral injury [Internet]. 2020. Available from: https://pds.wv.gov/attorney-and-staff-resources/continuing-education/Pages/LVTM.aspx

15.

Feinstein A, Pavisian B, Storm H. Journalists covering the refugee and migration crisis are affected by moral injury not PTSD. JRSM open. 2018;9(3):2054270418759010. https://doi.org/10.1177/2054270418759010.CrossRefPubMedPubMedCentral

16.

Haight W, Sugrue EP, Calhoun M. Moral injury among child protection professionals: implications for the ethical treatment and retention of workers. Child Youth Serv Rev. 2017;82:27–41. https://doi.org/10.1016/j.childyouth.2017.08.030.CrossRef

17.

Haight W, Sugrue E, Calhoun M, Black J. Everyday coping with moral injury: the perspectives of professionals and parents involved with child protection services. Child Youth Serv Rev. 2017;82:108–21. https://doi.org/10.1016/j.childyouth.2017.09.025.CrossRef

18.

Haight W, Korang-Okrah R, Black JE, Gibson P, Nashandi NJC. Moral injury among Akan women: lessons for culturally sensitive child welfare interventions. Child Youth Serv Rev. 2020;110:104768. https://doi.org/10.1016/j.childyouth.2020.104768.CrossRef

19.

Patterson JE, Edwards TM, Griffith JL, Wright S. Moral distress of medical family therapists and their physician colleagues during the transition to COVID-19. J Marital Fam Ther. 2021;47(2):289–303. https://doi.org/10.1111/jmft.12504.CrossRefPubMedPubMedCentral

20.

Haller M, Norman SB, Davis BC, Capone C, Browne K, Allard CB. A model for treating COVID-19-related guilt, shame, and moral injury. Psychol Trauma. 2020;12(S1):S174–6. https://doi.org/10.1037/tra0000742.CrossRefPubMed

21.

Williams RD, Brundage JA, Williams EB. Moral injury in times of COVID-19. J Health Service Psychol. 2020;46(2):65–9. https://doi.org/10.1007/s42843-020-00011-4.CrossRef

22.

Gaitens J, Condon M, Fernandes E, McDiarmid M. COVID-19 and essential workers: a narrative review of health outcomes and moral injury. Int J Environ Res Public Health. 2021;18(4). https://doi.org/10.3390/ijerph18041446

23.

Park-Lee E, Lipari RN, Hedden SL, Kroutil LA, Porter JD. Receipt of services for substance use and mental health issues among adults: Results from the 2016 national survey on drug use and health. CBHSQ Data Review. Rockville MD2012. p. 1–35

24.

Steinmetz SE. Measuring perpetration-induced distress in civilian populations [dissertation/thesis]. University of Wyoming; 2018. ProQuest Dissertations Publishing

25.

Steinmetz SE, Gray MJ, Clapp JD. Perpetration-induced distress scale. PsycTESTS Dataset: American Psychological Association (APA); 2019

26.

Steinmetz SE, Gray MJ, Clapp JD. Development and evaluation of the perpetration-induced distress scale for measuring shame and guilt in civilian populations. J Trauma Stress. 2019;32(3):437–47. https://doi.org/10.1002/jts.22377.CrossRefPubMed

27.

Hartman JS. The implications of moral injury among African American females with a history of substance abuse: a preliminary study [doctoral dissertation]. Pepperdine University; 2015. Pepperdine Digital Commons

28.

Van Herik E. Moral injury on the home front: can a new approach provide fresh insight into spirituality and alcoholism? [thesis]. Georgia State University, 2015. https://scholarworks.gsu.edu/rs_theses/49

29.

Burkman K, Purcell N, Maguen S. Provider perspectives on a novel moral injury treatment for Veterans: initial assessment of acceptability and feasibility of the Impact of Killing treatment materials. J Clin Psychol. 2018;75(1):79–94. https://doi.org/10.1002/jclp.22702.CrossRefPubMed

30.•

Currier JM, Drescher KD, Nieuwsma J. Future directions for addressing moral injury in clinical practice. In: Currier JM, Drescher KD, Nieuwsma J, editors. Addressing moral injury in clinical practice. American Psychological Association; 2021. p. 261–72. Designed with clinicians in mind, this book gathers a number of approaches and interventions targeting moral injury. The final chapter attempts to summarize where the field is currently and to offer suggestions for future directions

31.

Battles AR, Bravo AJ, Kelley ML, White TD, Braitman AL, Hamrick HC. Moral injury and PTSD as mediators of the associations between morally injurious experiences and mental health and substance use. Traumatology. 2018;24(4):246–54. https://doi.org/10.1037/trm0000153.CrossRef

32.

Currier JM, Holland JM, Jones HW, Sheu S. Involvement in abusive violence among Vietnam Veterans: direct and indirect associations with substance use problems and suicidality. Psychol Trauma Theory Res Pract Policy. 2014;6:73–82. https://doi.org/10.1037/a0032973.CrossRef

33.

Maguen S, Nichter B, Norman SB, Pietrzak RH. Moral injury and substance use disorders among US combat Veterans: results from the 2019–2020 National Health and Resilience in Veterans Study. Psychological Medicine. 2021; 1–7. https://doi.org/10.1017/S0033291721002919

34.

Spanagel R, Weiss F. The dopamine hypothesis of reward: past and current status. Oxford: Elsevier Ltd; 1999. p. 521–7.

35.

Di Chiara G, Bassareo V. Reward system and addiction: what dopamine does and doesn’t do. Curr Opin Pharmacol. 2007;7(1):69–76. https://doi.org/10.1016/j.coph.2006.11.003.CrossRefPubMed

36.

Hasin D, O’Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, et al. DSM-5 criteria for substance use disorders: Recommendations and rationale. Am J Psychiatry. 2013;170(8):834–51. https://doi.org/10.1176/appi.ajp.2013.12060782.CrossRefPubMedPubMedCentral

37.

Doran KM, Rahai N, McCormack RP, Milian J, Shelley D, Rotrosen J, et al. Substance use and homelessness among emergency department patients. Drug Alcohol Depend. 2018;188:328–33. https://doi.org/10.1016/j.drugalcdep.2018.04.021.CrossRefPubMedPubMedCentral

38.

Thompson RG Jr, Wall MM, Greenstein E, Grant BF, Hasin DS. Substance-use disorders and poverty as prospective predictors of first-time homelessness in the united states. Am J Public Health. 2013;103(S2):S282–8. https://doi.org/10.2105/ajph.2013.301302.CrossRefPubMedPubMedCentral

39.

White AM, Hingson RW, Pan IJ, Yi HY. Hospitalizations for alcohol and drug overdoses in young adults ages 18–24 in the United States, 1999–2008: results from the nationwide inpatient sample. J Stud Alcohol Drugs. 2011;72(5):774–86. https://doi.org/10.15288/jsad.2011.72.774.CrossRefPubMedPubMedCentral

40.

Donovan C. Food insecurity among adults with substance use disorders. Yale University; 2018

41.

Henkel D. Unemployment and substance use: a review of the literature (1990–2010). Curr Drug Abuse Rev. 2011;4(1):4–27.CrossRefPubMed

42.

Scherer M, Worthington EL, Hook JN, Campana KL. Forgiveness and the bottle: promoting self-forgiveness in individuals who abuse alcohol. J Addict Dis. 2011;30(4):382–95. https://doi.org/10.1080/10550887.2011.609804.CrossRefPubMedPubMedCentral

43.

O’Connor LE, Berry JW, Inaba D, Weiss J, Morrison A. Shame, guilt, and depression in men and women in recovery from addiction. J Subst Abuse Treat. 1994;11(6):503–10. https://doi.org/10.1016/0740-5472(94)90001-9.CrossRefPubMed

44.

McGaffin BJ, Lyons GCB, Deane FP. Self-forgiveness, shame, and guilt in recovery from drug and alcohol problems. Substance Abuse. 2013;34(4):396–404. https://doi.org/10.1080/08897077.2013.781564.CrossRefPubMed

45.

Snoek A, McGeer V, Brandenburg D, Kennett J. Managing shame and guilt in addiction: a pathway to recovery. Addictive Behaviors. 2021;120:106954. https://doi.org/10.1016/j.addbeh.2021.106954.CrossRefPubMed

46.

Alcoholics Anonymous Big Book. 4th ed. New York, NY: Alcoholics Anonymous World Services; 2002

47.

CDC/National Center for Health Statistics. Drug overdose deaths in the U.S. top 100,000 annually [Internet]. November 17, 2021. Available from: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm.

Titel: Moral Injury in the Context of Substance Use Disorders: a Narrative Review
verfasst von: Jessica Van Denend, PhD
J. Irene Harris, PhD
Brian Fuehrlein, MD
Ellen L. Edens, MD, MPE
Publikationsdatum: 01.12.2022
Verlag: Springer International Publishing
Erschienen in: Current Treatment Options in Psychiatry / Ausgabe 4/2022
Elektronische ISSN: 2196-3061
DOI: https://doi.org/10.1007/s40501-022-00280-4

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Moral Injury in the Context of Substance Use Disorders: a Narrative Review

Opinion statement

Neu im Fachgebiet Psychiatrie

Hörschwäche erhöht Demenzrisiko unabhängig von Beta-Amyloid

So wirken verschiedene Alkoholika auf den Blutdruck

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

ADHS-Medikation erhöht das kardiovaskuläre Risiko

Update Psychiatrie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Opinion statement

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2022

Characterizing Social Determinants of Health in Research Regarding the Clubhouse Model for Individuals with Mental Health Conditions

Repurposing Anti-inflammatory Agents for Mood Disorders: an Updated Review of Current Evidence

Evaluating the Use of Glucagon-Like Peptide 1 for the Treatment of Cognitive Dysfunction in Individuals with Mood Disorders

Neuromodulation as an Augmenting Strategy for Behavioral Therapies for Anxiety and PTSD: a Narrative Review

The Importance of Context: Using Social Determinants of Health to Improve Research and Treatment of Posttraumatic Stress Disorder

MAOI or ECT? Patient Preference and Joint Decision-Making in Treatment-Resistant Depression

Neu im Fachgebiet Psychiatrie

Hörschwäche erhöht Demenzrisiko unabhängig von Beta-Amyloid

So wirken verschiedene Alkoholika auf den Blutdruck

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

ADHS-Medikation erhöht das kardiovaskuläre Risiko

Update Psychiatrie