BACKGROUND:Despite Scotland's commitment to patient-centred substance use care, little is known about how individuals learn of residential rehabilitation. This study explores whether national policy goals of informed decision-making translate into on-the-ground practice.

METHODS: This paper presents a secondary analysis of data generated during a larger mixed-methods evaluation of residential rehabilitation. Participants (n = 197 people who reported a drug problem in the previous 12 months) were recruited from 29 Scottish Local Authority areas and completed structured face-to-face interviews. Peer researchers with lived experience conducted interviews. Qualitative data were thematically examined according to macro-level (systemic), meso-level (community), and micro-level (individual) influences.

RESULTS: Many participants reported never being informed of residential rehabilitation by healthcare providers. In response, peers, family, and community support groups filled information gaps, though their accounts were inconsistent or contradictory. Consequently, individuals resorted to micro-level strategies, such as internet searches and repeated questioning of key workers, to piece together essential details. Participants frequently expressed frustration with missed opportunities to explore alternative treatment pathways, compounding a sense of systemic neglect and disempowerment. This dynamic interplay between macro, meso, and micro factors often hindered genuinely informed decision-making and undermined policy ambitions for accessible, rights-based care.

CONCLUSIONS: Findings highlight pervasive communication gaps, echoing other contexts where new or less-familiar treatment options remain poorly signposted. Mandated communication protocols, formal peer collaboration, and reduced burdens on individuals could strengthen the alignment between practice and Scotland's National Mission. By closing these knowledge gaps, services can better support people with problem substance use to make truly informed decisions about residential rehabilitation and broader treatment pathways.