Background <p>Adolescent substance use is a rising public health concern in Ghana, with limited evidence on youth perspectives regarding service availability and access.</p> Objectives <p>This study explores the adolescents’ perspectives on the barriers to accessing substance use services in Northern Ghana.</p> Design <p>A qualitative exploratory design was employed.</p> Setting <p>This study was conducted in public senior high school in the Bolgatanga Municipality of the Upper East Region of Ghana.</p> Participants <p>Fifteen students aged 12 to 19 years were purposively selected with diversity in age, sex, religion, and residency status.</p> Data collection <p> Data were collected through in-depth interviews and analyzed thematically using Braun and Clarke’s framework. Trustworthiness was ensured through member checking, peer debriefing, and audit trails.</p> Results <p>The study identified several barriers grouped under four themes as follows: stigma, fear and confidentiality concerns, accessibility and affordability challenges, service relevance and adolescent-focused, and peer factors.</p> Conclusion <p>This study found that adolescents in Northern Ghana face significant barriers to substance abuse service use, shaped by four key themes: stigma and confidentiality concerns, accessibility and affordability challenges, lack of adolescent-friendly services, and peer influence. These barriers, rooted in systemic, structural, and sociocultural contexts, foster mistrust, limit access, and discourage help-seeking. Addressing them requires adolescent-responsive interventions that prioritize confidentiality, affordability, accessibility, and supportive care aligned with young people’s lived experiences.</p>