Literature has supported that, along with physical and psychological injuries, combat profoundly impacts veterans’ moral and spiritual belief systems and may contribute to negative health behaviors. Moral injury is a developing construct related to negative consequences associated with war-zone stressors that transgress military veterans’ deeply held values and belief systems. Additionally, spiritual injury addresses negative responses to an event that damages their relationship with God, self, and others, and alienates an individual from that which gives meaning to their lives. The purpose of the present study was to examine the relationship between combat exposure, morally injurious experiences (MIEs), spiritual injury, and hazardous alcohol use among U.S. active duty personnel, National Guard/Reserves, and veterans. Data were collected via online survey of 380 (260 men, 120 women) U.S. active duty personnel, National Guard/Reserves, and veterans. Participants completed the Combat Exposure Scale (CES; Keane et al., 1989), the Moral Injury Questionnaire – Military version (MIQ-M; Currier, Holland, Drescher, & Foy, 2015), the Spiritual Injury Scale (SIS; Berg, 1994), and the Alcohol Use Disorder Identification Test (AUDIT; Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). Greater combat exposure, MIEs, and spiritual injuries were hypothesized to be positively associated with higher hazardous alcohol use. Additionally, both MIEs and spiritual injury were hypothesized to mediate the relationship between combat exposure and hazardous alcohol use. Further, a double mediation (combat exposure → MIEs → spiritual injury → hazardous alcohol use) was expected. Gender was also explored as a moderator of the mediated relationship between combat exposure, MIEs, and hazardous alcohol use. As expected, combat exposure, MIEs and spiritual injury were positively correlated with hazardous alcohol use. Results of a mediation analysis revealed that MIEs mediated the combat exposure-hazardous alcohol use relationship. However, spiritual injury did not significantly mediate the combat exposure-hazardous alcohol use relationship. A follow-up moderated mediation analysis revealed that gender significantly moderated the mediational path between combat exposure, MIEs, and hazardous alcohol use, such that the mediation was only significant among men. Results suggest that MIEs and spiritual injury are associated with hazardous alcohol use; however, MIEs may only explain the relationship between combat exposure and hazardous alcohol use for men. These results point to the importance of understanding how links between combat exposure, MIEs, and hazardous alcohol use may be nuanced by gender. Further, these results have implications for screening and trauma treatment among military members and veterans
