Theses Doctoral

States, Selves, and Social Welfare: the American Therapeutic State in Comparative Perspective

Aleksanyan, Alexander Joshua

This dissertation advances our understanding of the variability and contingency of addiction treatment, a consequential social institution that simultaneously helps and regulates populations within criminal justice and healthcare systems. To do so, this dissertation draws on administrative and survey data, as well as archival and ethnographic research. I show that addiction treatment is structured by social, institutional, and historical contexts within which Americans are embedded.

Together, the three chapters demonstrate the utility of venturing across time and place as a method of interrogating the distinction between care and control. Using macro-sociological theory and research, aspects of the project also help broaden our understanding of addiction treatment as vital to the enactment of contemporary state governance. I refer to this as therapeutic statecraft.

Chapter 1 looks at how legal coercion is used to force people into rehab and how this practice is influenced by the interplay between state welfare and punishment systems. I find that coerced treatment is less common in states with broad and benevolent welfare systems that offer alternative pathways for residents to receive care and avoid minor encounters with the criminal justice system. Moreover, the extent to which poverty affects a state’s reliance on the criminal justice system as a referral source is contingent upon the degree of interpersonal surveillance facilitated by the broad administrative reach of state welfare systems. Furthermore, coerced treatment typically has a more disruptive, institutional character under punitive state contexts (i.e., strong-arm rehab).

Chapter 2 reveals how racial disparities in state-mandated, community-based drug treatment referrals are exacerbated in places with racially punitive criminal justice systems and surveillance-oriented welfare systems. These systems work together to discreetly extend penal power in the name of recovery for a population segment.

Chapter 3 examines changes in the care of sexual minorities at a specialized drug treatment facility over the past 30 years. The study finds that while staff members previously saw sexual stigma and discrimination as the source of addiction, current staff members use sexual stigma to regulate patients' "addictive tendencies," and may risk exacerbating stigma and inequality by losing sight of the broader underlying causes of addiction. Taken as a whole, the project’s findings contribute to our understanding of the significance of addiction treatment in contemporary times, particularly within the context of social policy and population management in the United States.

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More About This Work

Academic Units
Thesis Advisors
Reich, Adam Dalton
Ph.D., Columbia University
Published Here
May 31, 2023