The promise begins at the gate.
For a family exhausted by addiction — by the disappearing money, the sleepless nights, the sudden changes in behaviour, the arguments and repeated promises that this time will be different — a rehabilitation centre can appear to offer something increasingly rare…an exit.
Someone will take over.
The patient will be removed from the streets, separated from the people and places associated with drugs and placed in an environment built around recovery. There will be doctors, counselling, routine and supervision. Or at least that is the expectation.
What happens after the gate closes can be something else entirely.
Across Bangladesh, drug rehabilitation has grown into a patchwork of government institutions and private residential facilities operating under widely varying conditions. Some provide professional care. Others struggle with shortages of psychiatrists, psychologists, doctors and trained addiction counsellors.
Former patients describe centres where people with radically different histories of drug use are confined together for months. Counsellors describe a field in which specialised training remains scarce. Regulators have repeatedly found centres operating without licences or required medical personnel.
And several former patients interviewed for this story described a peculiar consequence of rehabilitation: They emerged knowing more about drugs than when they entered.
“I learned more about drugs and where to find them from other patients than I ever knew before,” Tushar (name changed to protect identity) told Daily Waadaa.
Another drug abuser, Adnan (name changed to protect identity) treated at a different facility, described a similar dynamic. Relationships established during treatment sometimes survived discharge, he said, creating networks among people who might otherwise never have met.
A system intended to break connections with drugs could, under the wrong conditions, create new ones. This is particularly troubling because Bangladesh is no longer confronting the drug problem it had a generation ago.
It is confronting yaba.
The small methamphetamine-and-caffeine tablet has altered the country’s narcotics landscape, becoming widely available even after years of seizures, arrests and some of the harshest drug laws in the region.
In June, Home Minister Salahuddin Ahmed said a government-supervised study estimated that nearly 5% of Bangladesh’s population had a drug addiction. With a population of roughly 175 million, that translates into millions of people.
The Irish Times recently described the transformation through a middle-aged Dhaka man identified by the pseudonym “Metalfreak,” whose life had become increasingly consumed by yaba.
Psychiatrist Md Arifuzzaman of the National Institute of Mental Health told the Irish newspaper that yaba addiction had become “very common,” while use was “significantly increasing.” He estimated that Bangladesh had only about 350 psychiatrists and argued that reducing substance use would require better mental-health services.
The Telegraph newspaper of the UK has also reported from inside Bangladesh’s yaba crisis, examining addiction through the country’s rehabilitation system. Together, the two foreign accounts have illuminated a contradiction Bangladesh has spent years avoiding: The country has constructed a formidable apparatus for fighting drugs, but a far thinner one for treating the people who become dependent on them.
The disparity can be measured in beds.
According to Department of Narcotics Control figures, Bangladesh had 386 private rehabilitation centres with about 6,100 beds. Nearly half of those facilities — 192 centres containing 3,252 beds — were in Dhaka. Fifteen districts had no rehabilitation centre at all.
The government system consisted of only four treatment centres, with an official capacity of 199 beds. Even that figure obscures the weakness of the institutions themselves.
At the Central Drug Addiction Treatment Centre in Dhaka, online news portal Dhaka Stream found only 30 beds available when it visited this year. Twenty-six positions existed for doctors. Two were filled. There was one psychiatrist, no clinical psychologist and five nurses against 15 sanctioned posts. Basic diagnostic facilities and an emergency department were absent.
These are not simply staffing shortages. They go to the heart of what rehabilitation means.
Addiction medicine is not custodial care. Removing access to a drug can begin treatment, but it is not treatment itself. Substance dependence can coexist with depression, anxiety, psychosis, trauma and family dysfunction.
Recovery can require psychiatric assessment, psychological therapy, counselling, medical care, family participation and months or years of follow-up after someone leaves residential treatment.
Yaba makes that challenge especially urgent because patients arriving at rehabilitation centres may have complicated psychiatric and behavioural symptoms requiring professional assessment.
Arifuzzaman told The Irish Times that some people who use drugs were already experiencing depression, anxiety disorders or psychosis and had initially turned to substances seeking relief.
Yet Bangladesh is attempting to treat addiction inside one of the most understaffed mental-health systems in Asia.
“Addiction counselling requires specialized training,” a psychosocial counsellor who works with people affected by substance use told Waadaa. “Many evidence-based treatment approaches used internationally are still not widely available in Bangladesh.”
That leaves a troubling question: If specialised professionals are absent, who is rehabilitating?
In some centres, former patients themselves become part of the therapeutic structure. Peer support can be enormously valuable in addiction recovery. Properly supervised therapeutic communities deliberately use the experiences of recovering patients to help others understand dependence, responsibility and relapse.
But the model depends upon structure. Without it, social chemistry can reverse.
People who have used drugs for years are placed alongside newcomers. They talk. They exchange histories. They describe neighbourhoods, dealers and substances. What is intended as a community of recovery can become an informal education in drug culture.
The former patient who said he learned more about drugs in rehabilitation was describing precisely that inversion.
It is difficult to know how common such experiences are. Bangladesh does not have the sort of transparent national outcome data that would make it possible to compare rehabilitation centres by relapse rates, staffing levels or treatment methods. But the regulatory record offers glimpses of a system that authorities themselves have repeatedly found wanting.
In November 2020, the Department of Narcotics Control sealed five unlicensed rehabilitation centres in Dhaka. The raids followed the death of senior assistant superintendent of police Anisul Karim at Mind Aid, a rehabilitation centre in Adabar.
Officials said Mind Aid had approval to operate as a drug rehabilitation centre but had been providing psychiatric treatment without authorisation. Its approval was revoked after Karim’s death.
During subsequent inspections, officials found other centres operating before receiving licences. At two facilities, the DNC found insufficient numbers of doctors and attendants. Three more unauthorised facilities were closed elsewhere in Dhaka.
A DNC official told Waadaa that rehabilitation centres were required to have full-time doctors and part-time psychiatrists, but none of the centres inspected had full-time doctors.
At the time, Bangladesh had about 350 licensed rehabilitation centres nationwide, according to the DNC. Six years later, the number has grown. The underlying questions have not disappeared.
Former patients interviewed for this story described facilities where confinement could become the organising principle of rehabilitation. Some alleged mistreatment. One counsellor, who requested anonymity because of the sensitivity of the issue, alleged that patients were sometimes admitted involuntarily and given medication without adequate assessment or meaningful informed consent.
Those allegations could not be independently verified. But they shed light on an unusual vulnerability inherent in residential addiction treatment.
The person entering rehabilitation may be distressed, intoxicated, psychologically unstable or in conflict with his family. Once admitted, he can be separated from the outside world and dependent upon the institution controlling his daily life.
The family, meanwhile, may be desperate. That desperation matters.
Addiction rearranges family life around itself. Parents and spouses can spend years negotiating, pleading, paying debts, searching for missing relatives and trying to distinguish manipulation from genuine promises of recovery.
By the time they turn to residential rehabilitation, the question may no longer be whether a particular centre practices evidence-based addiction medicine. It may simply be: Can you take him?
A locked door can begin to look like treatment.
Some interviewees alleged that family disputes occasionally influenced admissions to rehabilitation centres. Such claims vary widely and cannot be generalised without individual clinical and legal investigation. But they underscore the importance of independent medical assessment and safeguards around consent.
The line between rehabilitation and detention becomes especially consequential when the institutions themselves are inadequately supervised.
One man interviewed for this story had experienced both rehabilitation and incarceration on a drug-related charge. His comparison was startling.
“If someone genuinely wants to recover, following the prison routine helped me stay away from drugs,” he told Waadaa.
He was not suggesting prison as treatment. What he remembered was structure: predictable hours, rules and a routine he could follow. That prison could compare favourably in any respect with a medical institution intended for recovery reveals something uncomfortable about the state of rehabilitation.
Bangladesh has traditionally approached narcotics from the opposite direction. It has treated drugs principally as a problem of supply and crime. Yaba provided the clearest demonstration. In 2018, the government of Sheikh Hasina launched a sweeping anti-drug campaign.
More than 200 people were killed within months, Al Jazeera reported, while tens of thousands were arrested. Amnesty International later said 466 people were killed during 2018 amid what authorities presented as an anti-drug campaign. International organisations raised serious concerns about extrajudicial killings.
Yet the pills kept coming.
In 2007, authorities confiscated 1.2 million yaba tablets in Bangladesh, according to figures cited by the United Nations Office on Drugs and Crime. Nearly two decades later, synthetic-drug production in the wider region has reached extraordinary levels.
A record 236 tonnes of methamphetamine were seized in East and Southeast Asia in 2024, 24 percent more than the previous year. Myanmar is believed to be the principal source of yaba entering Bangladesh.
The enforcement machinery grew. So did the addiction.
Today yaba can be found deep inside Dhaka and far beyond it. The Irish Times described young people openly selling packets of pills in parts of the capital. The drug that was once relatively expensive has become cheaper and more accessible.
The rehabilitation system facing this transformed narcotics market remains extraordinarily small.
And its weaknesses are reinforced by the country’s wider mental-health shortage. Bangladesh’s 2018-19 national mental-health survey found an enormous treatment gap. Arifuzzaman told The Irish Times that psychiatrists at the National Institute of Mental Health might see 20 patients in a single hour because there was no alternative.
For addiction treatment, that scarcity is magnified. A centre can put the word rehabilitation on its signboard. It can install beds, hire attendants, impose a schedule and lock its doors. None of those things creates a functioning addiction-treatment programme.
Doing that requires trained people.
It requires psychiatrists capable of identifying coexisting mental disorders; psychologists and counsellors trained specifically in substance dependence; doctors able to manage medical complications; nurses; individual and group therapy; protocols protecting patients from abuse; family counselling; and aftercare capable of following patients into the environments where relapse actually occurs. Above all, it requires understanding addiction as a chronic health condition rather than a temporary moral failure that can be disciplined away.
That distinction is particularly important in Bangladesh because responsibility for rehabilitation sits within the institutional architecture of narcotics control.
The Department of Narcotics Control operates under the Home Ministry — the same broad state machinery responsible for enforcement — rather than addiction treatment being principally rooted in the public-health system.
The arrangement can shape the way the problem itself is understood.
A patient leaves the locked gate and returns to the same city where the pills remain inexpensive and accessible. He may return to unemployment, family conflict, friends who use drugs or an untreated psychiatric condition. The routines imposed during residential treatment disappear overnight.
This is where rehabilitation either becomes recovery or merely an interruption.
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