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The Weight of Service: Trauma, Moral Injury, and the Unbroken Program for First Responders

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References

References

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  • Bonumwezi, J. L., Tramutola, D., Lawrence, J., Kobezak, H. M., & Lowe, S. R. (2022). Posttraumatic stress disorder symptoms, work-related trauma exposure, and substance use in first responders. Drug and Alcohol Dependence, 237, Article 109439. https://doi.org/10.1016/j.drugalcdep.2022.109439
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  • Lewis-Schroeder, N. F., Kieran, K., Murphy, B. L., Wolff, J. D., Robinson, M. A., & Kaufman, M. L. (2018). Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues. Harvard review of psychiatry, 26(4), 216–227. https://doi.org/10.1097/HRP.0000000000000176
  • Maguen, S., Griffin, B. J., Pietrzak, R. H., McLean, C. P., Hamblen, J. L., & Norman, S. B. (2026). Prevalence of Moral Injury in Nationally Representative Samples of Combat Veterans, Healthcare Workers, and First Responders. Journal of general internal medicine, 41(2), 424–430. https://doi.org/10.1007/s11606-024-09337-x
  • Maguen, S., de Bourbon, S., Batten, A., Mason, M., Sloan, A., Nazzareta, D., Graterol, J., Pang, S., & Worthen, M. (2025). Prevalence of exposures and moral injury in first responders. Journal of the American College of Emergency Physicians Open, 6(6), 100259. https://doi.org/10.1016/j.acepjo.2025.100259
  • Morland, L., & Woolley, J. (2025). Psychedelic-assisted therapy for PTSD. U.S. Department of Veterans Affairs, National Center for PTSD. https://www.ptsd.va.gov/professional/treat/txessentials/psychedelics_assisted_therapy.asp
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  • Substance Abuse and Mental Health Services Administration. (2023). National Survey on Drug Use and Health (NSDUH): Veterans and substance use. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2023
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  • Witkowski, K., Lofaro, R. J., Headley, A. M., Contreras, S., Remington, C. L., & Ganapati, N. E. (2024). Understanding problematic substance use among first responders during the COVID-19 pandemic: A survey of law enforcement, fire, and EMS workers in the United States. International Journal of Drug Policy, 123, Article 104261. https://doi.org/10.1016/j.drugpo.2023.104261
  • Woller, S. J., Hall, K. E., McGrew, S. J., Anderson-Fletcher, E., Norman, S. B., & Vujanovic, A. A. (2025). Examining moral injury and posttraumatic stress among firefighters, emergency medical services personnel, and emergency dispatchers. European Journal of Psychotraumatology, 16(1), Article 2510019. https://doi.org/10.1080/20008066.2025.2510019
  • U.S. Department of Veterans Affairs. (2024). 2024 National Veteran Suicide Prevention Annual Report – Part 2 of 2. https://www.mentalhealth.va.gov/docs/data-sheets/2024/2024-Annual-Report-Part-2-of-2_508.pdf?utm_