Fig. 1

Challenges for implementation of substance use treatment and prevention services in conflict-affected populations. We adapted the Exploration, Preparation, Implementation and Sustainment (EPIS) framework developed by Aarons and colleagues to describe challenges for implementing substance use treatment and prevention interventions in conflict-affected populations into those existing within the inner and outer context [29]. Challenges related to the service environment, inter-organizational environment, and lack of consumer advocacy were identified in the outer context. Inner context implementation challenges relating to characteristics of the program or implementing organization included absorptive capacity and competing priorities. Lack of innovation-values fit of substance use services within the system and organization manifested through multiple forms of stigma