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The scholarship on therapeutic justice within drug treatment courts has been dominated by insights from the Global North. Organisational structures, mindsets, and discourses have been primarily explored through the lens of English-speaking, common law jurisdictions, leading to a specific understanding of the punitive culture within these rehabilitative environments. Drug courts have been criticised for not being able to renounce frameworks reliant on punishment and instead creating a form of “therapy with teeth”. This paper aims to shift the lens towards drug treatment courts in the Global South, specifically Chile, and interrogate the place of punishment in their development. Drawing on rationales of marginal criminological realism, the paper reflects on the syncretism between therapeutic rationales, rights concerns and neoliberal penal populism in an attempt to ultimately understand if drug treatment courts have the potential to transcend cyclical efforts to reinvent punishment, and, if so, under what conditions. Findings from stakeholder interviews and court observation showcase key insights on the benefits of a cultural awareness on rights, as well as the challenges posed by competing notions of responsibilisation and societal insecurity.