Why Client Autonomy is Considered Sacred In Substance Use Disorder Treatment

November 10, 2025

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

Reviewed by Wes Arnett, Subject Matter Expert  

Client autonomy should be sacred in substance use disorder (SUD) treatment because it acknowledges individuals as unique, empowered agents with the right to make their own choices, fostering self-determination and a deeper connection to their recovery process. Respecting autonomy is crucial for ethical treatment, building trust, and promoting the client's sense of responsibility and accountability, which ultimately supports resilience and long-term remission.

Author Joshua Bennett-Johnson is a Licensed Addictions Therapist, LADC-II, at JBJ Counseling in Newton, MA. He specializes in working with individuals and families navigating substance use and recovery. 

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

For 17 years, I struggled with substances and alcohol use disorder, in addition to depression, anxiety, isolation & loneliness. The desperation of that lifestyle motivated me to try my luck at being an outlaw. I wasn't very good at that. 

Everything came to a screeching halt when I was convicted of a felony, unarmed bank robbery in 2009. I've been a non-user ever since, and I view my work as a form of penance for my past misdeeds, as well as an opportunity to help others avoid hitting the proverbial "rock bottom" that I did, thereby living a healthier & more manageable life. I'm now a productive member of society: a husband, a father, a taxpayer, a helper. No longer the victim of an "unfair world", I approach each day knowing I'm one of the lucky ones who survived my addiction, while so many others didn't. I foster & nurture a grateful heart, dedicate my life to service, and live a life I never thought possible.

Recovery is a journey filled with challenges. It involves vigilance, dedication, commitment, and, above all, support. If I could have improved on my own, I would have done so long ago. I credit my well-being to the many helpers I've had along the way, and I'm proud to follow in their footsteps. If recovery were easy, everyone would be doing it. It's not. But the right things in this life are often the most difficult. And, the work pays off -- in dividends.

Today, I live a life of purpose, meaning, and the knowledge that I can face any obstacle that comes my way. What a gift! No longer does "life suck". It isn't easy, sure. Stressful, yeah. Challenging, you bet. But I get to show up for it. I'm living life today. Life isn't living me. That could be what freedom is. At any rate -- call it what you will: it's the most challenging thing I've done, and the best thing I've done.

Kat's Story

For the sake of privacy and anonymity, we're going to call her "Kat". I chose "Kat" because there was a ferociousness to her energy. Kat was from the streets, and you could feel it. She was tough. Hardened. A survivor. A warrior. A fierce adversary. And, generally, just a bad mo-fo. I was scared of Kat. Well, maybe not scared, but intimidated. 

And when my clinical supervisor told me that I would be Kat's primary counselor at the clinic, I was a little shaken and wary. No, wait. Let's be honest. I was terrified of Kat.

She might have been half my size, but if it ever came to blows, I had absolutely no doubt in my mind that Kat could take me to the proverbial woodshed and, with little effort, leave me lying in a bloodied heap. Kat also had zero interest in being in the clinic to begin with. 

Despite her tough exterior, Kat had made a series of decisions that were not conducive to her well-being. These decisions, which I will not delve into for the sake of her privacy, led to a district court judge mandating her to seek help for her problematic substance use. This is how she ended up under my care at the clinic.

Now, despite her badassery, there was also a very guarded, nearly hidden softness to Kat. It's all in the eyes. With the right kind of gaze, in very infrequent moments, you could see the glimmer of something that I might describe as gentle or tender, or even a little bit warm in those dark eyes, but it wasn't what she led with. Her hardness was her go-to, her suit of armor, and it had served her well out on the streets. It had kept her alive, as Kat had found herself in some hazardous situations with dangerous characters along the way.

She was 22 years old. She wasn't one to share in group therapy as a matter of course, but when she did, it was always to the point that she didn't want to be there to begin with, and when she did share, it was all, "fuck the courts", "fuck the system", "fuck the world", "fuck” all of it. Fuck it all.

In Solitude

She was a loner. She smoked alone. She ate her lunch alone. She sat alone, between groups, outside, scrolling on her phone or chatting with people who were still out there, running the streets and hustling various enterprises they were involved in, which she could no longer participate in, at least for a while.

She had a beautiful laugh, one that was spontaneous, loud, and genuine, bursting out occasionally. No, when Kat received a message from a friend on her iPhone, she would occasionally let out an unbridled laugh that was drenched in joy and enthusiasm.

Self-Guarded

When she wasn't laughing, however, she remained challenging and intimidating, ever guarded, and she kept her distance from anyone and everyone, no matter how much effort the other clients made to invite and embrace her into the fold.

As a treater, it was obvious to me: Kat had been hurt, and likely many times, in severe ways, over many years. That's why you couldn't get near her. That's why she wouldn't "let you in". If you couldn't get close to her, you couldn't hurt her. 

She was going to take preemptive and effective measures to protect herself from that possibility. But as a treater, what's also true is this: I'm never in the business of intentionally trying to hurt anyone. I'm a helper, a healer. My goal is always to do my best to help and not overwhelm the clients in my care, regardless of how challenging or intimidating they may be.

First Session

But how was I going to help Kat, specifically? I was stymied.

Our first session? Oh, man. I went in scared, and Kat went in angry. Those two energies flying around my tiny office were a visceral, energetic mess of a thing. She stared at me with that oppositional, dead-eyed look. I looked back at her with as much gentleness and compassion as I could muster, but my look betrayed whatever vibes I was putting out there, and Kat could feel that better than most, because she had street smarts. She knew I was scared, and she liked it that way. A scared therapist is easy to work with, as they're unlikely to have the courage to try to crack through that tough exterior to uncover the feelings lurking beneath.

Despite my intimidated energy, I had also been doing this work for a few years by this time, so I was able to "break through" my palpable wariness and attempt to start a dialogue with Kat. It didn't amount to much, but we had to start somewhere. It sounded something like,

"Listen, I get the impression that you don't want to be here. I've heard you say as much in groups. You probably don't want to be sitting with me in this session right now. I'm guessing you don't want to begin therapy in the first place. But we have about an hour to kill, so tell me, Kat, what do you want to talk about?"

Rage Explosion

She exploded. "Motherfucker, you don't know anything about what I want or what I don't want, don't be coming at me with your assumptions! You don't know where I'm from or what I'm about! How dare you come at me, acting like you're familiar with me! You don't fucking know me! Who the hell do you think you are?!? Some expert on who I am or what I want?!? You know absolutely nothing about who I am, what I want, what I don't want, so don't talk that mess to me! You have no idea about the things I've been through to end up here or what I'm trying to do with my life!"

That's just a taste of the scolding I got. Kat's diatribe went on for a good five minutes before she started winding down. She got so loud that a few colleagues knocked on the door to check if I was okay and if all was safe. I assured them it was and hurried them away because I knew, within that explosion, I had found the key to how Kat and I were going to move forward with one another. She was going to be my assigned client for at least 3 months, maybe more, and her tantrum revealed the answer to the question that had been haunting me before that initial session:

The Suit of Armor 

How is a 30-something-year-old white boy from the suburbs going to get through to a woman, ten years his junior, who grew up in the world of real-deal gang-bangers? That question had been on my mind since her arrival at the clinic, particularly after observing her behavior in groups and noting her lack of engagement with the other clients enrolled in the program. How was I going to access the real woman hiding behind that suit of armor? Her walls were strong and fortified impressively, but there's never a wall that you cannot dismantle. You have the blueprint to view the design, which shows how it evolved into a wall. And Kat had just revealed the secret to its construction.

Her ranting, however dramatic, came to an end, and I sat there with her for about 10 minutes in complete and utter silence. The silence was so loud, it was deafening, and it left her very confused. Instead of looking at me with that intimidating gaze, she was now looking away from me at different points within my office. I hadn't fled from her vicious, verbal attack on me. I had sent my colleagues packing when they came to check that all was well, and now I was gazing at her with soft eyes, a hint of gentle amusement, and a whole lot of compassion that I'm sure she could feel.

"You know what, Kat?" I replied, "You're right." I kept my voice firm, yet very level, with an energy of empathy and curiosity attached to it. "I don't know anything about you. I don't know where you're from or what it was like for you before you landed here with us. I don't know what you've been through in this life, but I'm willing to bet there's been some hard shit that you've had to navigate. And, no, I'm no expert. Shit, I'm not even an expert on myself! I'm still trying to figure out how I got here!"

She laughed that beautiful laugh. I leaned in. "Hey, Kat," I went on, "You are the expert in this room, not me, and what I can tell you is this: you're 100% right. I don't know shit about you except for one thing: you didn't get here by accident. You're not just some victim of circumstance. But I also want you to know this: if you want and are willing to tell me about the things that I don't know about you, so that you and I can get to know each other, and find some real shit to talk about, I'm here for it."

Interested in reading another case study? Read Rebuilding From the Ashes

She went dead silent for a few ticks, and then the tears came. And for the next 30 minutes, I sat in silence as Kat cried for what had probably been the first time in a very long time, and the cleansing of pain began. When she started to collect herself, I leaned in again, and I asked her, "So, what do you think, Kat? Would you like to give it a try with me? Would you like to get to know me? And I can get to know you, too?"

No words, just a sorrowful smile, and she nodded emphatically, a signal that told me, "yes". What a beautiful moment that was.

It was one of those breakthrough moments that we therapists dream about: you say just the right thing, at just the right time, in just the right way, and under just the right circumstances, and it hits the client right in their heart. It breaks through the wall, touching their wounded soul, the hurting inner child. Moments like that don't happen often, but when they do, they are transformative beyond description.

Kat and I went on to work together for the next five years. She ultimately achieved a healthy recovery, although it was a bumpy journey to get there. But we found it. She found gainful employment. She ended up marrying her longtime partner, another woman in recovery. She called me up one day a couple of years ago to report to me that through the miracle of IVF treatments, her wife would soon be having twins, and that they were saving up for a condo, getting closer to securing that down payment, and getting their credit scores up to pre-qualify for the loan.

New Beginning

Talk about a new beginning. No longer the gangster, Kat was soon going to be a Mama. Autonomy.

It's sacred, and it's the only best practice there is when we are genuinely trying to help someone get better, always upholding their autonomy and independence, so that they can discover that all this time, they had all the answers inside of them about how they were going to heal from the wounds of their hurt. What they needed was someone who would let them be themselves, allowing their voice to be heard without judgment, condemnation, or any influence over their ability to design their own lives and recovery in a way that feels right for them.

Upheld by autonomy, it's a simple formula. Helping people to help themselves is accomplished by giving them the power to do so and by being a good listener—a good ally. And never pretending that we, the credentialed clinician, are the expert in the room.

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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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