Trajectories of harm and relapse in adolescent substance use: a qualitative study from Sri Lanka

Adolescent substance use is a growing public health concern in low- and middle-income countries, yet context-specific qualitative evidence remains limited. This study explored the lived experiences of adolescents undergoing inpatient rehabilitation for substance use in Sri Lanka. A qualitative descriptive study was conducted among 62 male adolescents aged 11–17 years at a tertiary rehabilitation centre in Kandy. Participants were purposively sampled. In-depth interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Participants described a cyclical trajectory from early normalization and limited risk awareness to progressive physical, psychological, and social harm. Substance use disrupted education, strained family relationships, and contributed to social isolation and legal involvement. Continued use frequently functioned as a coping mechanism for emotional distress, including grief and family conflict. Attempts at cessation were common but often unsuccessful due to cravings, peer influence, and interpersonal stress, leading to recurrent relapse. Despite this, adolescents expressed hope for recovery alongside fears of relapse. Adolescent substance use is a socially embedded, cyclical process. Effective interventions must extend beyond detoxification to include integrated mental health care, family-centred approaches, and support for social reintegration.