Why We Need a More Compassionate Approach to Substance Use Treatment

February 2, 2026

Joshua Bennett-Johnson, Author and  Licensed Addictions Therapist, LADC-II

Tom O'Connor, Publisher

After seven years in a clinical setting, Joshua transitioned to private practice, where he has spent the past six years helping clients at all stages of recovery. He believes in client autonomy and works alongside each person to discover the path to their healing. As a harm reduction advocate, Joshua focuses on education, safety, and reshaping relationships with substances. 

According to Joshua Bennett-Johnson:

"They" are our friends. Our family members, sons, daughters, siblings, nieces, and nephews. Our coworkers and colleagues, as well as those who manage our employment. Our teachers. Our healthcare providers. Our neighbors. Our service workers. 

"They" are sometimes us, ourselves, we who have problematic relationships with drugs, alcohol, gambling, sex, retail shopping, the pleasure-seeking "they" seek is wholly irrelevant, because here's what's really going on.

We focus on the behavior, rather than the person who lives beneath it. And in this American culture, our focus skews toward that which is punitive, shaming, blaming, and shunning due to the stigma that remains alive and well against those who struggle with vices.

My own struggles began at a very young age, in my pre-teen years. Amidst the behavior of substance or alcohol use itself, I was also a young person who was acting out. I would give my teachers a hard time; I was the consummate' class clown'. I would skip class, ditch school, and was forever branded as the kid who "has a lot of potential, if only he would apply himself". I was told this countless times before being informed that I would face a consequence for my behavior. Suspended from school. Demerits. Detention.

But when I look back now, I cannot help but ask myself, 'How come none of the adults at the school ever asked me a question like,' Hey Josh, what's going on at home? "' How are you doing? Are you safe when you leave school in the afternoon? Are any of your peers giving you a hard time or bullying you?" 

Not once during my four-year high school career was I ever on the receiving end of an inquiry from a teacher, guidance counselor, principal, or anyone else about what was going on inside me or in my life outside the institution. Instead, it was always the story of my "bad behavior" and the corresponding punishment that I would receive.

That's a heavy trip to lay on a kid whose brain isn't going to be fully developed until he hits his late 20s.

We're Doing It Wrong

Similar to the experiences of many students in primary schools across the nation, we're doing the same thing in the field where I work. We are focusing on the behavior rather than the person behind it, and taking the same punitive, alienating approach to their experiences as we do to users. We are ashamed. We are to blame. We shun. We lay the whole heavy trip of their ability to get well on them, with the aid of other people who have had the same trip laid upon them.

Self-help groups. Other outcasts. They who have been driven away from their communities and their families by their communities and their families because of the behavior in which they are engaging. As disappointing as it is, that is the prototypical model of most modern treatment centers when it's time for the client to leave their controlled environment of care: "Go to meetings, get a sponsor, do the steps, don't use/drink, blah, blah, blah."

Now, with respect to 12-step groups, yes, in their long and storied history, they have helped countless people "stay sober a day at a time". However, if you do a little digging, you'll soon learn that their overall "success rate" on a grand scale is nothing short of abysmal, hovering around 6-7%, and the messaging surrounding their approach to being healthy and productive members of society is completely dysfunctional and misguided. Sorry to the true believers, but 12-Step Self-Help is not evidence-based treatment, and I've had hundreds of clients tell me that they felt worse coming out of the meeting than they did before going in.

Those people in those church basements attending those meetings? They are not the healthiest cross-section of individuals that you're ever going to encounter in this society. What brought them to those groups to begin with are horrifying stories of trauma, abuse, neglect, violence, but, more importantly, a belief that they have internalized by those charged to treat them that they are 'beyond repair'. They are sick, they are always going to be ill, and there's no cure for what they have. This is what they tell the newcomer, because this is what they were told when they were new, and sadly, this is also what clinicians in treatment centers told them.

Even if they've been able to stay sober for decades, what other group members tell them is that "their disease is still out there, doing push-ups in the parking lot", growing ever-stronger every day, just an arm's length away from what is imbued within the individual, that they have a brain that they can never trust. They are essentially a relapse waiting to happen when disaster strikes.

What do you think inspires the individual who hears this message from people whom they believe have the answers as to how to treat their problematic use? Hope? Self-belief? Self-confidence? And in this adult life, at some points along the way, disaster always strikes, in myriad ways. So, when it does, and it always does, the inevitable result is often that which the recovering person fears most: relapse. A return to the behavior that they've been trying to steer clear of for all that time, while always believing that they are doomed by the life sentence of what is generally described as "Addiction" or "Alcoholism".

And what of the people who do not choose abstinence as a path toward their recovery? Well, they're essentially not embraced by the other "addicts" and "alcoholics" in those basements. If they are trying to practice moderation, they are told they are not allowed to share. If they are using certain medications to manage symptoms or as a replacement therapy, prescribed by an MD, they are told they are not allowed to share. If they dare question the "stay sick" model, they're going to be ostracized by the outcasts. I've seen it too many times to count.

Anyone who is trying to live a life in recovery can do it. They can get great at it. But before they get great at it, they have to get good at it. And before they get good at it, they have to get not-so-good at it. Before that phase, they have to try. They are the ones who make it in recovery; whatever the recipe entails, it's the ones who try and keep trying. They don't throw in the towel or pull the ripcord too soon, and having a good helper and evidence-based modalities helps us achieve outstanding results.

In my practice, I've seen more people achieve and maintain good health and build beautiful, sustainable lives than those who didn't or couldn't. No two journeys are the same. If there were one way to get better, there would be one book—a blueprint. There ain't. Want to know why? It's because every individual pursuing recovery is a phenomenon in their own right. What works for one person won't necessarily work for the next. We need to honor that in therapy, in inpatient treatment, in outpatient programs, and in Medication-Assisted Therapies.

But the overarching point is this: it's not "Them", it's "Us". We are the ones who need to look beyond the behavior and examine the person underneath. Anyone who you've ever encountered who has a problem with drugs or alcohol or whatever, they are all dying to be seen, heard, respected, known, valued, understood, and loved. They don't want to be told that they are a "hopeless case," an inevitable relapse waiting to happen. They want to be told they can achieve and maintain health, and build beautiful, sustainable lives for themselves from now until their card is called.

We are placing a heavy burden on the person who is suffering and filling them with the lie that they are beyond hope. The truth of the matter is this: if you can get someone unwell to buy into the idea that they can get well, stay well, and be well for the rest of their days, you're going to see positive outcomes. You'll see people who are not driven by fear, but by hope.

You're going to see people who embody self-belief, self-confidence, self-efficacy, and the faith they need to propel themselves toward solutions rather than problems.

It's not a life sentence of doom and gloom. It's a life you can build with a strong support network that will surpass your wildest dreams, and it's a fantastic thing to witness.

How do we do this as treaters, family members, colleagues, friends, and so on? We do it by not laying that heavy trip on the client, but on ourselves, and we open up our minds to the fact that you cannot push or talk someone into feeling safe enough to open up about their trauma. We do it by seeing past the behavior, at the wounded human who lives beneath, and we make every effort we can to let them know.

You are seen. You are heard. You are known. You are respected. You are valued. And, most important of all. You are loved.

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To learn more about Joshua Bennett-Johnson's work, please visit his website at https://jbj-counseling.com/

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