Addiction governance as a racialised syndemic: recursive organised abandonment, punitive recapture, and the politics of care

Purpose This article examines how addiction treatment and drug policy can reproduce mental health inequality and social exclusion, and it conceptualises contemporary addiction governance as a racialised addiction syndemic. Design/methodology/approach Drawing on comparative published case studies from Eastern Europe and Central Asia (EECA) and the UK, this article combines syndemic theory with critical scholarship on race, drug policy and organised abandonment to analyse how governance structures shape addiction-related harm through racialised and colonial logics. Findings In the EECA, post-Soviet narcology and the withdrawal of international donors that fund drug treatment services interact to produce recursive organised abandonment – a feedback loop in which state-sanctioned disinvestment triggers service interruptions, mortality and non-compliance among drug users that justifies further punitive control. In the UK, racialised policing of cannabis use generates chronic stress and criminalisation among Black and mixed-race communities. This study identifies a process of punitive recapture, wherein survival and coping strategies adopted by populations abandoned by the state are weaponised by the state to pull individuals back into carceral control and systemic exclusion. Research limitations/implications As a conceptual paper based on existing published work, further empirical research is needed globally to explain how addiction governance contributes to mental health inequality. Practical implications Because punitive governance and racialised surveillance function as structural determinants of addiction treatment inequality, expanding addiction treatment without dismantling these infrastructures risks reproducing harm. Reform must decouple care from policing, prioritise continuity of care and support community-led models based on social justice. Social implications Racialised addiction governance shapes access to care, belonging and social inclusion, disproportionately affecting marginalised communities. Originality/value This study explicitly theorises addiction treatment as a racialised addiction syndemic, positioning drug governance as a constitutive force in the production of social injustice and social harm.