Substance use in adolescents is not merely an individual risk behavior; it is a multifaceted social problem shaped by school, family, and institutional structures. This qualitative research aims to uncover the ethical and institutional dimensions of school-based interventions by examining the experiences of teachers, counselors, and school administrators who intervene with middle school students who use substances. The study is interpreted within the framework of Ecological Systems Theory, Stigma Theory, Care Ethics, and Institutional Theory. Data were collected through semi-structured in-depth interviews with 70 educators and analyzed using thematic analysis. The findings focus on five main themes: lack of information and experience, procedural ambiguity, institutional ethical breaches, concerns about school stigma, and parental anxiety. The results show that intervention processes are often hampered by legal concerns, pressure on institutional reputation, and fear of social stigma. The research conceptualizes school-based interventions not as a technical implementation process, but as a tension zone between care-oriented ethical responsibilities and bureaucratic control mechanisms. In this respect, the study offers a unique contribution by highlighting the need for structural reform among policymakers and practitioners.