“We need to keep in mind that battle fatigue”: A commentary on moral injury among substance use treatment and community service providers [commentary].
Introduction: Moral injury is the psychological distress resulting from actions, or the lack thereof, which violate one’s moral or ethical code. There is a notable gap in literature exploring moral injury among substance use disorder (SUD) treatment and community service providers. Despite the lack of literature describing moral injury among the SUD workforce, moral injury was discussed extensively during meetings of the Community Representative Council (CIRCL) of the National Drug Abuse Treatment Clinical Trials Network (CTN), which engages community members within the CTN Nodes to understand perspectives of people with lived/living experience and those providing substance use services.
Methods: In response to this consistently raised topic, this commentary reviews the literature on moral injury related to the SUD workforce, as well as the perspectives of CIRCL members on the unique and persistent challenges faced by SUD treatment and community services providers.
Results: Members of CIRCL in the SUD treatment and community provider workforce consistently described experiencing morally injurious events, including acts of commission and omission, bearing witness, and observing betrayal from those in power. While some experiences are akin to those experienced by providers in other healthcare settings, some were unique to front-line SUD treatment and community services providers. These experiences caused intense experiences of guilt, isolation, and hopelessness, sometimes contributing to turnover.
Conclusions: Addressing moral injury among the SUD provider workforce may require unique mitigation and prevention strategies, potentially involving structural changes at the organizational, social, and policy levels that support the SUD treatment and community service workforce, ultimately improving not just the wellbeing of providers and patients, but the wellbeing of our communities.