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Young people in residential alcohol and other drug (AOD) services build meaningful relationships with workers during their stays. In this paper we use an ethics of care framework to explore what young people said about care, how it was delivered and what they valued about it. Drawing on three waves of longitudinal interviews conducted with 38 young people over 12 months, we discuss our findings according to two overarching themes – opportunities enabled by care and limits to care. Young people’s descriptions highlight the potential for care to challenge stigma, enhance self-worth and wellbeing, enable respectful staff-client relationships, and foster positive relationships crucial for maintaining engagement. At the same time, young people described challenges around providing both individual and collective care, coproducing care in structured environments, and facilitating care as young people transition out of residential services. These findings shed light on the delicate balance between care provision and contextual constraints within AOD settings. This emphasises the need for ethical relationships built on clear communication, mutual respect, and ongoing forms of care. Recognising the value of care work, especially in transitions out of acute treatment services, is essential for reshaping funding approaches to prioritise meaningful and continuing care. [ABSTRACT FROM AUTHOR]

Young people who attend intensive alcohol and other drug (AoD) treatment commonly do so more than once. This paper aims to understand precipitators, enablers and barriers to young people's re-engagement in programs. Data come from a longitudinal qualitative study involving three waves of interviews with Australian young people recruited while attending intensive AoD programs (n = 38 at wave 1). We found that young people's ambitions for what they might achieve with a new stay and capacity to benefit from programs, evolved. Skills learnt in earlier stays or changed life circumstances often helped them achieve better outcomes subsequently. Ongoing contact with an AoD worker was the most important enabler to service re-engagement. Across the span of a year, we saw most young people in our study sample develop a stronger sense of wellbeing and control over substance use. While researchers tend to focus on evaluating outcomes associated with single stays at specific programs, young people think about their trajectories towards managing substance use and their lives as occurring more holistically, supported by engagements with a range of services. We argue that the notion of incremental treatment is useful in depicting the synergistic effects of service engagement over time., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)