General Moral Injury Scale (GMIS): Scale Development and Association With Drug Misuse Behavior in Two Samples

“Moral injury” occurs when adults have concerns about experiences that challenge their sense of right and wrong. Past research with veterans, refugees, and youth has provided measures of moral injury concerns, which are often associated with negative outcomes such as depression, anxiety, anger, and suicide ideation. The present study adds to the literature by developing a brief General Moral Injury Scale (GMIS) for more widespread application and by adding drug misuse behavior as a possible negative outcome associated with moral injury. Study participants included Sample 1 of 436 U.S. adults and Sample 2 of 291 adults in drug treatment. Participants completed surveys to report demographics, responses to eight items of moral injury concerns, and measures of drug misuse behavior for depressants, stimulants, and hallucinogens. Exploratory factor analysis with Sample 1 and confirmatory factor analysis with Sample 2 supported three GMIS subscales: Personal Betrayal, Transgressions by Others, and Transgressions by Self. Comparisons of the three moral injury concerns as predictors of drug misuse revealed that Personal Betrayal was associated with misuse by all three drug types for Sample 1 (depressants, stimulants, and hallucinogens) and two drug types for Sample 2 (depressants and stimulants), whereas Transgression by Self was associated with hallucinogens for Sample 1 and depressants for Sample 2. Clinicians could use the GMIS to identify whether clients experience moral injury concerns most linked with drug misuse and select interventions to reduce these concerns by increasing a sense of safety, forgiveness, and/or self-compassion.