The mandatory, state-subsidized treatment opened up by drug courts and other jail and prison diversion programs have massively expanded the numbers of the nation's poor and working class who are labeled addicts and sent to rehab, making drug rehabilitation a primary site for the re-socialization and control of the poor. Drawing on ethnographic and interview data, this article examines the institutional form at the center of this process: the 'strong-arm' rehabilitation facilities most closely tied to drug courts, probation, and parole. The therapeutic community tradition's long-standing practices of moral reform through intensive behavior modification are now mobilized by the state on a large scale, transformed into a 'fuzzy edge' of the criminal justice system which resocializes far more intensively than most forms of incarceration. We understand the 'medicalization' represented by strong-arm rehab not as a reprieve from judgment, but instead as a process of translation and amplification. Translated by staff into therapeutic, moral, and finally cultural versions, the biochemical 'diagnosis' of pathology comes to serve as a neutral, medicalized front behind which the systemic injuries of race and class disappear. Instead, the strongarm process amplifies the taint of addiction into a new biologization of poverty and race.

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Drawing on ethnography and interviews with recovering men in the Twin Cities, Minnesota, this study explores how two dominant models of American rehab are racialized — coerced treatment theorizing addiction as criminal personality—and a more medicalized, voluntaristic model rooted in the brain disease paradigm. At the “carceral rehab” of “Arcadia House,” staff assumed its majority court-mandated, poor men of color would arrive resistant to reforming their “lifestyle addictions,” justifying treatment backed by (re)incarceration. In contrast, “Healing Bridges” offered its gentler, “medical-restorative rehab” to mostly white, middle-class patients who escaped incarceration despite substantial participation in drug-related crime. While both programs mobilized the colorblind logic that “addiction doesn’t discriminate,” local disparities routed recovering men into vastly different treatments, disproportionately criminalizing the addictions of the Black poor. In a racialized binary operating across the field, Arcadia’s clients of color were viewed as sicker and more out of control than Bridges’ white patients. While Arcadia’s clients required coercive state management, Bridges’ patients were understood as already possessing the capacity for self-management—reinforcing staff’s mission to empower the non-addict within. Distinctions between coerced and voluntary treatment were naturalized and mapped onto recovering men, reproducing race at the most intimate levels of self-making.