Chasing Recovery: Governance, Accumulation, and Mobility in Philadelphia’s Drug Treatment Network

Philadelphia is one of the cities leading the decarceration movement unfolding across the country, having reduced its jail population by close to 50 percent over the past four years. My dissertation focuses on one of the primary jail alternatives utilized by the courts: a combination of community-based nonprofit recovery houses and intensive outpatient treatment centers that provide housing and behavioral health treatment for referred clients. This form of community-based treatment emerged in the 1980s and 1990s from the managed care revolution in healthcare.

The emergence of this treatment structure coincided with the radical austerity measures of the 1980s and the gutting of welfare provisions and public social services. Private nonprofit treatment providers stepped up to care for their communities, using direct fee-for-service Medicaid payments to compensate for the loss of social service funding. Using addiction and mental illness treatment as an umbrella for GED, vocational, physical health, and other types of services, these providers stepped in for the community centers that had lost funding, and compensated for jail overcrowding in the 1990s by accepting court-mandated clients. Today, this network of treatment providers is accepting higher and higher rates of court-mandated clients under the new decarceration imperative. As a result, the system has corporatized and become far less community-based. In my research, I found that clients and counselors alike lamented the loss of the community-based model and the decline of wrap-around services. I found, too, that the provision of these services had become a primary source of jobs for the working and lower-middle classes in Philadelphia. In fact, many directors and counselors working in the field have themselves recovered from substance abuse and/or criminal justice involvement. In short, the privatization of social services and the rise in managed care opened up a critical opportunity for mobility in Philadelphia’s most under-resourced communities, a small window that is now closing due to corporatization and conglomeration.

I couple these findings on the implications of the privatization of healthcare and social services with research on the rise in mass incarceration to illuminate key features of the transformation of Philadelphia’s poorest communities since the 1980s. I find that structural exclusion from mobility opportunities endures in Philadelphia’s poorest communities for both small businesses/organizations and individuals. I observe both community-based service providers struggling to stay afloat amidst the corporatization of behavioral health treatment, and their clients struggling to obtain any form of long-term employment. My dissertation highlights the continuities between the mass incarceration and decarceration eras and argues that decarceration cannot solve the underlying issues of unemployment, limited economic mobility, and the consequences of extreme privatization and corporatization of healthcare and social services.

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