Trapped but Trying: Stigma, Sexual Motivations, and the Everyday Struggles of Recovery from Psychoactive Substance Use Among Youth in Rural Ghana

Background Psychoactive substance use among youth in rural Ghana is shaped by intertwined biopsychosocial factors, including cultural norms, gender expectations, relational dynamics, and structural disadvantage. Recovery for these young people extends beyond abstinence, comprising moral, social, and emotional efforts to rebuild dignity, belonging, and wellbeing. Despite rising substance use in Ghana, limited empirical work explores how youth understand their use and navigate recovery within rural contexts. This study examined the lived experiences of young people with current or prior psychoactive substance use in a rural Ghanaian community, focusing on how social, cultural, and relational contexts shape their substance use trajectories and recovery efforts. Methods A qualitative design grounded in a constructivist interpretivist approach was adopted. In-depth interviews were conducted with fifteen youth aged 19–33 years in a rural district in Ghana. Interviews explored participants’ experiences, motivations, struggles, and reflections on substance use and recovery. Data were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis to identify patterns of meaning and everyday struggles embedded in their social worlds. Results The findings indicate that recovery is a complex, fluid, and socially embedded process. Four interconnected dimensions shaped substance use and recovery: (1) personal motivations linked to sexual performance and masculine identity; (2) peer dynamics and the social ecology of drug availability; (3) stigma, exclusion, and the reinforcing cycle of dependence; and (4) structural barriers to care and community-based pathways to recovery. Participants described tramadol and similar substances as tools for demonstrating masculinity, enhancing sexual performance, and securing social validation. Stigma, shame, and fear of judgment, combined with limited access to mental healthcare and mistrust of institutions, impede help-seeking. Despite these barriers, participants expressed the need for community-based, compassionate, and non-judgmental recovery support that respects their vulnerabilities and strengths. Conclusions Substance use and recovery among rural Ghanaian youth are best understood holistically within a biopsychosocial framework that integrates individual experience with broader cultural, social, and structural contexts. Gender norms, stigma, and resource constraints significantly shape substance-use trajectories and recovery attempts. Effective interventions must therefore extend beyond biomedical models, incorporating gender-sensitive, community-grounded approaches that promote social inclusion, empathy, and sustainable wellbeing.