Understanding Moral Injury in Veterans: A Hidden Struggle Behind PTSD and Addiction

Moral injury among veterans can emerge from situations such as:

• Taking part in or witnessing harm to others, including civilians, even when following orders.

• Failing to prevent injury or loss of life, despite best efforts.

• Feeling betrayed by leadership, peers, or institutions, causing a loss of trust.

• Being involved in choices that conflict with personal values, such as rules of engagement that lead to unintended outcomes.

These morally injurious events can profoundly affect how a veteran sees themselves, their role in the world, and their sense of worth.

Moral injury can have deep and lasting effects on a veteran’s mental health and overall life:

Psychological Impact

Veterans may experience persistent guilt, shame, self-condemnation, and difficulty forgiving themselves. These feelings often lead to destructive thought patterns, low self-esteem, and struggles with identity.

Emotional and Behavioral Changes

Common reactions include withdrawal from relationships, avoidance of triggers or reminders of the event, and difficulty connecting with loved ones. Some may turn to substance use as a way to numb or escape painful emotions.

Spiritual or Existential Distress

Moral injury can also trigger crises in faith or belief systems, causing veterans to question previously held spiritual or moral frameworks.

Overlap with PTSD and Other Conditions

Though moral injury is not PTSD, the two often co-occur and can intensify each other’s symptoms. Veterans struggling with moral injury may also experience PTSD, depression, anxiety, or increased suicide risk.

For some veterans, the emotional weight of moral injury can contribute to substance misuse and addiction as a coping mechanism. When difficult emotions like guilt and shame feel unbearable, turning to alcohol or drugs may seem like a way to dull the pain. Over time, this can develop into a substance use disorder or co-occurring mental health condition.

Dual diagnosis — when addiction and mental health conditions coexist — is especially common among veterans. The moral distress that comes from unresolved experiences can make it harder to engage in treatment and heal holistically.

Recognizing and addressing moral injury is critical not only for mental health but also for preventing long-term damage like chronic addiction, relationship breakdown, and social isolation.

Supporting a loved one through moral injury requires compassion, patience, and understanding:

1. Listen Without Judgment

Create space for veterans to share their stories and feelings without pressure or assumptions. Acknowledging their experience can help reduce isolation and shame.

2. Encourage Professional Support

Therapeutic support that specifically addresses trauma, guilt, and moral distress can make a significant difference. Veterans may resist therapy due to shame, so gentle encouragement is key.

3. Understand Triggers and Challenges

Recognize that seemingly small reminders — anniversaries, news stories, or social dynamics — can trigger emotional responses. Being attuned to triggers helps loved ones provide better support.

4. Promote Healthy Coping and Connection

Encourage participation in healthy activities, support groups, spiritual or community involvement, and routines that foster stability and meaning.

5. Prioritize Patience and Consistency

Recovery is not linear — setbacks can happen. Maintaining a consistent presence of care and understanding builds trust and encourages healing.

At Sierra Health + Wellness Centers, the Veterans Program offers comprehensive treatment tailored specifically for veterans facing addiction and mental health challenges, including those rooted in trauma and moral injury.

Specialized, Veteran-Centered Care

Sierra Health + Wellness understands that veterans have unique experiences and needs after service. The Veterans Program incorporates evidence-based therapies and a trauma-informed approach to support recovery from addiction and address co-occurring mental health issues such as PTSD — conditions often intertwined with moral injury.

Supported Transition to Civilian Life

By providing inpatient and outpatient treatment options, individualized care plans, and therapeutic support that acknowledges military experiences, Sierra Health + Wellness helps veterans navigate the complex journey toward healing and renewed purpose.

Integration with VA Benefits

The Veterans Program works with benefits like TRICARE and VA Community Care, helping veterans access quality care with support navigating insurance and coverage.

Holistic and Comprehensive Services

From group therapy to trauma-focused counseling and relapse prevention, the Veterans Program supports the whole person — addressing both addiction and the emotional wounds of moral injury.

If you or a loved one are a veteran struggling with the hidden wounds of moral injury, addiction, or mental health challenges, Sierra Health + Wellness is here to help with compassionate, veteran-focused care.

Moral injury is a profound but often overlooked impact of military service that extends beyond traditional trauma. It can deeply affect a veteran’s sense of self, relationships, and overall health, often intertwining with addiction and mental health struggles. With compassionate support from loved ones and specialized treatment programs like those at Sierra Health + Wellness, veterans can begin the journey toward healing, reconciliation, and renewed meaning in life.