Psychology Department, Ariel University, Israel.
The Weinberg Child Development Center, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Israel.
Addict Behav. 2022 Jan;124:107114. doi: 10.1016/j.addbeh.2021.107114. Epub 2021 Sep 7.
Cannabis use is highly common among military combat veterans, who are also inclined toward developing Cannabis Use Disorder (CUD). The present study examined the association between Moral Injury (MI), which may occur following combat-related acts that violate one's deep moral beliefs, and CUD, as well as the mediating role of depression and the moderating role of perceived social support.
Participants were 215 Israel Defense Forces male combat veterans discharged from military service within the past five years, who reported using cannabis regularly (≥3 days weekly) during the past six months. Participants completed a set of validated self-report questionnaires assessing MI, CUD, depression and perceived social support.
Results indicated that MI-perpetration by self and MI-betrayal were positively associated with CUD. Additionally, serial mediation analyses indicated that the associations between MI-self and betrayal and CUD were mediated by depression (direct effect: β = 0.13, p = 0.1, and β = 0.20, p = .04, respectively). Furthermore, moderation analyses indicated that the association between MI and CUD was significant only among participants with average or high levels of perceived social support (for support by a significant other: b = 0.13, p = .006 and b = 0.22, p < .001 for MI-self and betrayal, respectively; for support by family: b = 0.13, p = .009 for MI-betrayal; and for support by friends: b = 0.1, p = .044 for MI-self).
MI and its association with CUD should be addressed in clinical settings when working with combat veterans.
大麻在军事战斗退伍军人中非常普遍，他们也倾向于发展大麻使用障碍（CUD）。本研究探讨了道德伤害（MI）与 CUD 之间的关联，道德伤害可能是由于与战斗相关的行为违反了一个人的深层道德信仰而产生的，以及抑郁的中介作用和感知社会支持的调节作用。
参与者为 215 名以色列国防军男性战斗退伍军人，他们在过去五年内退伍，过去六个月内每周至少有三天定期使用大麻。参与者完成了一套经验证的自我报告问卷，评估 MI、CUD、抑郁和感知社会支持。
结果表明，自我和 MI 背叛的 MI 实施与 CUD 呈正相关。此外，序列中介分析表明，MI 自我和背叛与 CUD 之间的关联通过抑郁来介导（直接效应：β=0.13，p=0.1，和β=0.20，p=0.04）。此外，调节分析表明，MI 与 CUD 之间的关联仅在感知社会支持处于平均或高水平的参与者中显著（对于重要他人的支持：b=0.13，p=0.006 和 b=0.22，p<0.001 分别为 MI 自我和背叛；对于家庭的支持：b=0.13，p=0.009 为 MI 背叛；对于朋友的支持：b=0.1，p=0.044 为 MI 自我）。
在与战斗退伍军人一起工作的临床环境中，应解决 MI 及其与 CUD 的关联。
