Moral injury and substance use among Veterans: Opportunities and challenges in rural areas

Veterans experience substantial health disparities, which are compounded in rural areas where health care access is limited. Many Veterans experience service-associated adverse mental health (MH) disorders and substance use disorders (SUDs). These may be exacerbated in rural communities where stigma toward MH disorders and SUDs may be prevalent. Thus, it is necessary to identify rural Veterans at risk of service-related MH-SUD and provide treatment outside the context of formal clinical venues. One means to intervene may be the implementation of field-based screening and treatment for moral injury (MI), which is recognized as being prevalent among military Veterans and is associated with SUD. Recent work has validated survey instruments that may quantify the degree of MI. Furthermore, new data indicate that a self-directed protocol may be effective in lessening MI impact. Both assessment and treatment are readily implemented in the field and may be effectively used by harm reduction organizations, which are already positioned to meet and address the needs of people who use substances and are trusted by their clients as health partners. Incorporating aspects of screening, treatment, and formal care referral may allow these organizations to serve as a bridge between rural Veterans with MH-SUD and formal medical care.