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Objectives: To study the determinants of psychoactive substance use among street teenagers living in Ouagadougou. Methods: Qualitative and quantitative cross-sectional study with street teenagers living on the Zogona campus in Ouagadougou, in September 2012. A focus group was then formed with eight members of the group. Results: The median age was 16 years (range: 12 to 20 years). The various psychotropic agents were tobacco, alcohol, gasoline, glue sniffing and cannabis. Seventeen of the 31 teenagers had already been admitted to a rehabilitation centre and none of them attended school at the time of data collection. However, 12 street teenagers had previously attended school. The main reasons for the presence of these teenagers in the street were “ poverty in the family”, “ death of the parents”, “ Koranic school”. The main reasons reported by the teenagers for substance use were “ to give oneself courage”, “ to relieve hunger”, “ to be like the others”, “ to be accepted by the group”, “ to protect oneself from the cold”. The main determinants of substance abuse were social exclusion, group membership, and group identification. Conclusion: Psychoactive substance use is an integral part of the life of street teenagers and is a major obstacle to social integration.