Moral Injury and Spiritual Struggles among Christian Adults with a History of Substance Use and Perceived Problematic Behaviors: A Phenomenological Study

The purpose of this qualitative phenomenological study was to describe the experiences of moral injury and spiritual struggles among Christian adults from the Philadelphia tri-state area with a history of substance use or perceived problematic behaviors. Moral injury (MI) is newly studied in civilian populations. In a review of 253 studies on moral injury and substance use, only two qualitative studies explored exposure to morally injurious events amid substance use rather than as a pathway to substance use. Due to the religious characteristics of the target sample, the grounding theory for this study is Fowler’s Stages of Faith Development, which can help to explain and conceptualize the spiritual dimension of moral injury. The current study’s findings confirm the presence and prevalence MI and corresponding emotional responses including expressions of deep guilt, shame, conviction and self-condemning views. MI occurred both before and after the onset of substance use with most individuals recalling detailed accounts of morally injurious events related to caregiver/parental moral failings, instances of relational betrayal unrelated to substance use, and early childhood exposures to sex and substance use. One’s religiosity and spirituality were found to bring comfort and discomfort to individuals experiences with their moral injuries and spiritual struggles, leading to God-avoidance behaviors and additional emotional distress.