Apartheid South Africa developed a notoriously punitive and racist approach to alcohol and drug use. Less reported is that the state gave significant attention to rehabilitation, first for the minority white population and later for black South Africans. This paper asks why in the post-apartheid era—despite a huge influx of cheap heroin, methamphetamines, and other drugs—the government showed a relative disregard for rehabilitation. Addressing this question, the paper points to the configuration of forces driving public rehabilitation in the colonial era included the upliftment of “poor whites,” the need to maintain black workers’ productivity, and the ascendancy of the disease concept of addiction. In the post-1994 period these forces waned as a multiracial middle class came to purchase treatment in private rehabilitation facilities, the disease concept fell into retreat, and mass unemployment helped to position poor black drug users as an “undeserving poor.” The paper contributes to comparative studies on penal-welfare systems and the recent attention to drug histories from the global South.