Background <p>Internationally, substance use recovery and healing is increasingly the focus of health and public policy and practice. Yet, what constitutes recovery and healing, and how it is understood and enacted among young people who use(d) drugs (YPWUD) has been largely underexplored. This commentary argues for a re-imagining of substance use recovery and healing by centering the understandings and lived experiences of YPWUD and their caregivers.</p> Methods <p>We draw on insights from a needs assessment conducted using qualitative methods with 38 youth (14 to 24 years of age) and 18 caregivers from across the province of British Columbia, Canada, including in Vancouver, Victoria, Kelowna, and Prince George. All activities were undertaken in collaboration with our team’s Youth Health Advisory Council, a group of 9 youth with lived experience of substance use and its various interventional responses.</p> Findings <p>We discuss key insights from the needs assessment, highlighting the urgent need for more nimble approaches to supporting youth recovery and healing that adapt to shifting definitions, goals, and timelines as well as transitions across various substance use treatment, recovery, and care contexts. Our needs assessment also highlighted the often overlooked but critical role of families and caregivers. By foregrounding youth perspectives and experiences – including engagements with diverse treatment, recovery, and care programs and complex dynamics with caregivers – we identify key priorities and actionable recommendations to reorient policy, practice, and research so that they are more youth- and caregiver-centered.</p>