Beyond the Law: A Qualitative Socio‐Ecological Study of Substance Use Treatment Barriers and Adaptations in Ghana

BACKGROUND: Ghana's response to substance use has long been dominated by criminalisation, yet limited research has examined how this policy environment shapes addiction treatment delivery. This study explored the perspectives of mental health nurses providing care to people who use drugs (PWUDs) using a socio-ecological framework. METHODS: An exploratory qualitative study was conducted with 20 mental health nurses in the Kumasi Metropolitan Area between April and July 2024. Participants were purposively recruited from diverse healthcare facilities. Semi-structured interviews explored factors influencing treatment provision at individual, interpersonal, organisational, community and policy levels. Interviews were audio-recorded, transcribed verbatim and analysed using Braun and Clarke's six-stage thematic analysis. A deductive approach informed by the socio-ecological framework was combined with inductive theme development. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: Four themes emerged: (1) structural and systemic barriers, including fragmented treatment pathways, limited rehabilitation facilities and resource inequities; (2) economic and access barriers shaped by financial constraints and family systems; (3) societal attitudes and criminalisation, where stigma and punitive policies discouraged treatment engagement while corruption enabled drug access and (4) adaptation and resilience, reflecting how providers and patients navigated system limitations through creative strategies. CONCLUSIONS: Mental health nurses deliver addiction care within significant structural constraints. A socio-ecological framework revealed how barriers operate across multiple levels, underscoring the need for public health-oriented drug policies, expanded treatment infrastructure and targeted workforce development to improve addiction care.