Severity, Patterns, and Psychosocial Determinants of Substance Use Disorder among Individuals in Rehabilitation in Western Maharashtra: A Mixed-methods Study

Abstract Background: Substance use disorder (SUD) remains a major public health concern in India, with rising prevalence among young adults. Evidence integrating clinical severity assessment with lived experiences in rehabilitation settings remains limited. Objectives: To assess the severity, patterns, and psychosocial determinants of SUD among individuals undergoing rehabilitation in Western Maharashtra using a mixed-methods approach. Methodology: A cross-sectional mixed-methods study was conducted across three rehabilitation centers using convenience sampling. Quantitative data were collected using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test and a structured socio-demographic pro forma. Descriptive statistics and Chi-square tests were performed to assess associations. Qualitative data were obtained through semi-structured interviews and were analyzed thematically to explore contextual determinants and treatment experiences. Results: The study population predominantly comprised young adult males with a mean age of 26.4 ± 6.66 years and a prolonged mean duration of substance use (68.8 months). Cannabis and alcohol were the most commonly reported substances, with a high proportion of daily use. A significant association was observed between substance type and route of administration (χ 2 = 307.0, P < 0.001). Severity patterns suggested moderate-to-high risk profiles among most participants. Qualitative findings revealed peer influence and curiosity as common initiation factors, while trauma, family conflict, stigma, financial barriers, and perceived inconsistencies in treatment quality sustained use and affected recovery. Conclusion: SUD in this rehabilitation cohort reflects substantial clinical severity intertwined with structural and psychosocial determinants. Integrated, trauma-informed, and quality-assured addiction care models are urgently needed.