Combat Veterans’ Experiences of Moral Injury, Cannabis Use Disorder and the Process of Meaning-Making: A Mixed Methods Study

Combat veterans are highly inclined to develop substance use disorders, including Cannabis Use Disorder (CUD), with emerging evidence suggesting that combat related Potentially Morally Injurious Events (PMIEs) may increase proneness to CUD. To explore the moderating role of time since release from military duty, mixed methodology was applied. In a quantitative study, 322 Israeli cannabis-using male combat veterans filled out validated self-report questionnaires assessing PMIEs, CUD and time since release from military duty. Results indicate that self-inflicted transgressions and sense of betrayal were significantly associated with CUD symptoms (<i>p</i> < .01). In addition, years since release from duty moderated the association between Betrayal and CUD (b=-.039, SE = .018, <i>t</i>=-2.20, <i>p</i> = .028), so that this association was significant only among veterans released approximately two and six years prior to their participation in the study (b = .33, SE = .09, <i>t</i> = 3.71, <i>p</i> < .001; b = .25, <i>t</i> = 3.45, <i>p</i> < .001, respectively), but not among those who were released approximately 10 years ago. A subsequent qualitative study investigated narratives of 14 older veterans, indicating that the process of meaning-making to combat-related experiences is a key in the process of adaptive coping. We conclude that time since release from duty may serve as a protective factor, presumably disentangling the PMIEs-CUD association via the process of meaning making.