<![CDATA[Background: Substance use disorder (SUD) imposes a complex, multidimensional burden that necessitates comprehensive and integrated rehabilitation services. Hospitals play a pivotal role in the delivery of rehabilitation; however, implementation remains constrained by limited specialized human resources, inequitable access to services, fragmented intersectoral policy coordination, and persistent stigma toward individuals with SUD. Purpose: To examine hospital-based rehabilitation for substance use disorders, with particular attention to service availability and conditions, program effectiveness, and the roles of key stakeholders. Method: A qualitative case study was conducted between April and June 2025 at Prof. Ildrem Psychiatric Hospital, selected primary health centers, and related institutions, including the Provincial National Narcotics Agency of North Sumatra, the Health Office, National and Political Unity Agency, Regional Research and Innovation Agency, the police, and community-based organizations. Fifteen key informants and ten triangulation informants were purposively recruited. Data were collected through in-depth interviews, non-participant observations, and document review, and were analyzed thematically using NVivo 12 through open, axial, and selective coding processes. Results: Seven major themes were identified: workforce capacity and competence, access to rehabilitation services, social vulnerability, program effectiveness, post-rehabilitation and community reintegration, policy processes, and stigma. Key barriers included shortages of addiction-trained professionals, complex and bureaucratic referral mechanisms, high non-medical costs, weak cross-sector collaboration, and insufficient aftercare services and community support systems. Conclusion: The findings indicate that hospital-based rehabilitation alone is inadequate to address the complex needs of individuals with substance use disorders. An integrated rehabilitation model that combines medical treatment, psychosocial interventions, community-based support, and coherent policy frameworks is essential. Enhancing professional capacity, streamlining referral pathways, expanding community-based aftercare, and implementing systematic stigma-reduction initiatives are critical to improving rehabilitation outcomes and promoting sustainable recovery.]]>
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