Finding ways to engage and retain young people in treatment for substance use is important in disrupting trajectories of dependence and long-term addiction. Research speaks to the complex interplay of system, client, and clinician factors influencing treatment attendance. This study used a qualitative approach to explore the views of clients (young people [n = 19] and their carers [n = 5]) on the enablers to treatment engagement and retention. Four themes were identified. First the power of first impressions in facilitating trust for young people accessing support. Second, the impact of caseworkers’ approach which acknowledge contextual influences on substance use. Third, young people’s appreciation for AOD workers who shared responsibility for initiating and building trust. Finally, the influence of patient and slow-paced case management styles on treatment attendance. Findings illustrate the importance of humanising approaches to AOD service provision, creating safe spaces in traditionally clinical and stigmatised environments, where biomedical models of care have dominated. The study highlights the potential incongruence between AOD workforce requirements/expectations, and the conditions needed (and sought after) to effectively support young people via good practice social work models.