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Background Syrians have been the largest group of refugees in Germany since 2014. Little is known about Syrian refugees` perspectives on substance use. The aim of this study is to investigate the perspective of male refugees from Syria and to foster specific knowledge and understanding of substance use. Methods We applied a qualitative study design. Five semi-structured focus group discussions with a total of 19 refugees were conducted in 2019 among the difficult to reach population of Syrian refugees. Audio recordings were translated and transcribed. We used a hybrid approach by integrating inductive and deductive thematic frameworks. Results We identified common themes. Firstly, refugees perceived that substances are widely available and accepted in Germany. Secondly, refugees perceived that rules and norms in Germany differ from rules and norms in the home country and favor availability of substances. Thirdly, substance use is related to the intention to escape the past. Fourthly, substance use is related to living in the present through connecting with others and being part of the community. Finally, mental health professional treatment for substance use is associated with shame. Conclusions Findings support Syrian refugees` perspectives of substance use as a way of both escaping the past and coping with psychosocial difficulties in the present in a socio-ecological understanding. Understanding the explanatory model of Syrian refugees can inform future interventions to prevent substance abuse and design tailored interventions. Further studies with Syrian refugees in more countries are needed to better understand resettled refugees` perspectives on substance use.

Background The study of substance use disorder among communities affected by mass violence has not received equal attention as other health concerns. This has led to the majority of psychosocial interventions in post-conflict zones being unresponsive to substance use-related problems among refugees. This study focused on gaining an in-depth understanding of the lay discourses and cultural concepts around substance use among male Syrian refugees in Germany. Methods Purposive and convenience sampling strategies were used for the recruitment of participants. The interview schedule was piloted among experts prior to conducting fieldwork. Inclusion criteria were a recent arrival from Syria. The study utilized a qualitative methodology, consisting of semi-structured group interviews with a native-speaking professional translator. The interviews were audio-recorded, transcribed and analyzed using an inductive thematic approach. Results Participants were refugees aged between 18 - 60 years (n = 19). The narratives revealed three themes. Firstly, the characteristics of Syrian society featured particularly in the participants' narratives. Society's rejection of substance use, generally enforced through taboos (e.g. halal/haram) was described and placed in contrast to a more liberal German society. Easier access and an open attitude to drug use in Europe were seen as problematic by some. The social stigma attached to mental health issues was discussed in participant narratives. Stigma was interpreted as both a cause for the development of a disorder as well as an exacerbating factor. Family was perceived as a protective force against substance use and the development of disorders. Thirdly, substance use was understood as one strategy of coping with stress, experience of violence and displacement. Conclusions Substance use may be seen as both an expression and a product of social suffering caused by the experience of war and displacement.