Objectives <p>This study examines how a defendant’s addiction, prior criminal record, race, and drug type impact public support for criminalized and medicalized sentencing approaches to illegal drug use, as well as how such support may be moderated by participants’ levels of essentialist thinking.</p> Methods <p>This study is a fully-crossed, randomized experiment with a lay public sample (<i>N</i> = 1208).</p> Results <p>Public support for medicalized approaches to sentencing was significantly higher for oxycodone and heroin. Support for criminalized approaches was significantly higher for crack and cocaine, and when the defendant was Hispanic, Black, or had a violent criminal record. Essentialist thinking generally predicted increased support for criminalized approaches, but increased support for medicalized approaches when addiction was known.</p> Conclusions <p>This research highlights the role of different factors in shaping public support for drug sentencing approaches, as well as suggests that public attitudes about drugs are deeply intertwined with societal narratives about race, addiction, and criminality.</p>