Abstract
Substance use disorders (SUDs) represent a critical public health challenge across India, with the Northeastern states—Arunachal Pradesh, Assam, Manipur, Mizoram, Meghalaya, Nagaland, Tripura, and Sikkim—experiencing high prevalence rates. Private rehabilitation centers have proliferated without adequate regulation, resulting in widespread human rights violations. These centers are largely driven by commercial motives rather than patient welfare. This viewpoint synthesizes government reports, judicial cases, media, and Non-Governmental Organisation (NGO) case reports to argue that converging evidence points to serious regulatory gaps in the private rehabilitation sector and advocate for region-specific regulatory mechanisms, especially tailored to Northeast India’s socio-political context.
Discussion
SUDs represent an alarming public health crisis across India. Still, the situation is especially acute in the Northeastern states, with the region experiencing substance use rates significantly higher than the national average. 1 The region has a strategic geographic location, as it shares borders with Bangladesh, Bhutan, China, Myanmar, and Nepal, creating one of the world’s largest drug trafficking corridors, the Golden Triangle. 2 This has contributed to an environment in which psychoactive substances are easily available, and vulnerable populations are exposed to multiple risks.
Nationally, despite investment in approximately 480 Integrated Rehabilitation Centers for Addicts (IRCAs), District De-Addiction Centers (DDACs), Addiction Treatment Facilities (ATFs) 3 and hundreds of private facilities, only 2.6% of alcohol-dependent individuals and 12% of drug-dependent individuals in the country have access to treatment, 4 creating a treatment gap that private centers exploit. These centers have become profit-driven enterprises that prioritize revenue generation over recovery, especially for the population of Northeast India, who are overtly vulnerable. 5
Evidence from systematic investigations, legal cases, and research demonstrates that many private rehabilitation centers subject vulnerable individuals to torture, illegal detention, and degrading treatment.6–9
This viewpoint, written from the perspective of a social work academic and researcher engaged with addiction services in Northeast India, examines the regulatory failures that enable violations and argues that several pieces of evidence converge to serious regulatory gaps in the private rehabilitation sector that place service users in private facilities at heightened risk of violations.
Approach to Evidence and Scope
This viewpoint synthesizes four main streams of evidence: (a) Peer-reviewed empirical and review articles on SUDs and treatment systems in India, with a focus on the Northeast; (b) national policy documents and legislation, including the Mental Healthcare Act (MHCA) 2017 and the Clinical Establishments (Registration and Regulation) Act 2010; (c) reports and orders from statutory bodies such as the National Human Rights Commission (NHRC), State Human Rights Commissions, and judicial decisions; and (d) media and civil-society reports documenting sentinel incidents of deaths, torture, and illegal detention in de- addiction and rehabilitation facilities.
Peer-reviewed literature was identified through searches of PubMed and Google Scholar using combinations of the terms “India,” “SUD,” “de-addiction,” “rehabilitation center,” “Northeast India,” “human rights,” and “regulation,” limited to English-language publications from 2000 onwards. Policy and legal documents were sourced from official websites of the Ministry of Health and Family Welfare, the Ministry of Social Justice and Empowerment, and state social welfare departments in the Northeastern states, as well as official gazettes and notifications.
Media reports were considered only when they described: (a) Deaths or serious physical injury within a de- addiction or rehabilitation facility; (b) rescue operations or closure orders by courts, human-rights bodies, or district administrations; or (c) formal investigations by statutory authorities, such as NHRC notices or state-level inquiry commissions. Allegations that lacked any corroboration from official inquiries, legal processes, or independent documentation were excluded. Greater weight is accorded to peer-reviewed research, national surveys, and statutory documents than to media or NGO reports. Therefore, normative recommendations in this viewpoint are primarily grounded in higher-level sources, with sentinel cases used to illustrate the lived consequences of regulatory gaps.
Terminology
In this article, the term “torture” is used in line with international human-rights standards, referring to the intentional infliction of severe physical or mental pain or suffering for purposes such as punishment, intimidation, or coercion, with at least tacit acquiescence of authorities. The phrase “systematic exploitation” is used to denote recurring, profit-driven practices such as prolonged involuntary confinement, excessive charges, or coerced labor that contravene legal requirements for consent, humane treatment, and professional standards of care.
The Magnitude of India’s Rehabilitation Crisis: From Treatment Gap to Exploitation
The treatment gap for substance use problems has created a lucrative market for private rehabilitation centers as vulnerable families become desperate for solutions to their problems related to addiction. The recent review by Molanguri, 4 highlights critical deficiencies across India’s de-addiction landscape: Unlicensed centers, substandard amenities, insufficient professional staffing, and coercive or abusive practices.
Indian newspapers have reported 13 deaths of patients beaten to death by staff at de-addiction centers, with over 1,080 individuals rescued from illegal detention between 2016 and 2019. Many residential de-addiction centers restrict patients from communicating with family members and restrict access to cell phones and the internet, despite regulations requiring all facilities to allow supervised communication between patients and families. 10
There are several recent incidents, including the death of a 24-year-old man beaten at a Dehradun center in 2023, which prompted the NHRC to issue notices to all states and union territories. 11 In Imphal, Manipur, there are instances of deaths due to physical violence inflicted by the staff of the centers. 12 The absence of qualified medical personnel in many centers is also a grave concern, as vulnerable individuals are left with no legitimate treatment while enduring systematic abuse. 4
The Inadequacy of Current Regulatory Frameworks
Three fundamental weaknesses in India’s current regulatory architecture include fragmented authority, inconsistent implementation, and inadequate enforcement mechanisms. The MHCA 2017 requires all substance use treatment centers to register as Mental Health Establishments, while the Clinical Establishments Act 2010 mandates separate registration. However, many states have failed to implement these requirements effectively, thereby creating a regulatory vacuum.13,14
The National Action Plan for Drug Demand Reduction (NAPDDR) guidelines have established minimum standards for government-supported facilities, but they lack binding authority over private centers.3,4,6 There are state-level variations as well, which further complicate the situation.
The Vulnerability of North-East India
Northeast India is extremely vulnerable on a geographical front. The region’s challenging terrain, ethnic diversity, ongoing conflicts with the Indian government, and demands for autonomy complicate service delivery. Drug consumption has shifted dramatically from smoking opium and heroin to injecting heroin and pharmaceuticals. This transition has driven HIV and hepatitis C epidemics, with Manipur earning the designation “AIDS capital of India” by the late 1990s. The shift to injecting pharmaceuticals has caused severe health complications, including life-threatening infections and amputations. 15
Substance use rehabilitation services in Northeast India are shaped by a dynamic interplay of national and state policy, health service infrastructure, cultural context, and local governance. 16 India has developed an evolving regulatory architecture, primarily anchored in national policy frameworks such as the MHCA 2017 and the Clinical Establishments (Registration and Regulation) Act, 2010. Still, the implementation of these policies and acts remains fragmented across the Northeastern states. 17
The situation in Northeast India warrants special attention due to its distinctive rehabilitation challenges. There is only one Drug Treatment Center in Assam under Drug De-Addiction Programme (DDAP). Under the aegis of NAPDDR, there is a growth in IRCAs, Outreach and Drop-in Centers, ATFs, and DDACs, but significant disparities in coverage, access, and regulatory oversight remain. 4 The regional coordination structure under DDAP in the Northeast, which includes the Regional Institute of Medical Sciences, Imphal (East Zone), primarily focuses on government facilities, thereby leaving private centers largely unmapped and unmonitored. 18
The Absence of Robust Oversight in Northeast India
Field investigations reveal disturbing patterns of coercive treatment practices in some private facilities, including forced detention, physical restraint, and punitive measures disguised as “therapeutic interventions.” 19 In Manipur, some reports indicate drug users were historically chained to benches in “treatment” centers to prevent escape, in the absence of medical care and frequent physical abuse. While some of these extreme practices have reportedly decreased due to advocacy efforts, there are persistent concerns about forced labor disguised as “work therapy,” justifying this as empowering clients while actually saving on labor costs. 15
The practice of “pickup” of SUD patients from their residences to rehabilitation centers, which is essentially “forceful admission” in its essence, represents the most severe form of coercion, which violates both national and international standards. 3 Such forced admissions occur with incompetent examination and advice from inexperienced or unqualified mental health professionals, raising serious concerns about staff and patient safety. Organizations such as the All-Manipur Anti-Drug Association and the Coalition Against Alcohol and Drugs are working closely with the government and are reportedly backed by armed groups. They have been reported as being aggressive toward drug users, dealers, and producers. 15
There are instances of deaths persisting due to aggravated cases such as physical assault and lynching in private rehabilitation centers across different states of Northeast India reported across research papers and media, as shown in the Table 1.20–26
Media-reported Malpractices in Private Substance Use Rehabilitation Centers in Northeast India.
These incidents represent documented sentinel events and are not intended to represent the statistical prevalence of malpractice across the region. FIR, First Information Report.
Disclaimer: These incidents represent documented sentinel events and are not intended to represent the statistical prevalence of malpractice across the region.
These cases, as reported in national and regional media and, in some instances, followed by human-rights or police investigations, are best interpreted as sentinel events rather than as prevalence estimates. They indicate that extreme violations, including deaths, serious physical assault, and illegal detention, do occur within the de-addiction and rehabilitation sector. Still, the absence of a systematic monitoring system makes it practically difficult to estimate how common such incidents are relative to the total number of centers or admissions.
The Regulatory Vacuum in Northeast India: Uncharted Territory for Private Facilities
The regulatory framework governing private rehab facilities varies across Northeastern states, as shown in the Table 2.
State-wise Regulatory Frameworks for Private Rehabilitation Centers (Eight States).
APDDS, Arunachal Pradesh Drug De-Addiction Society.
This fragmentation creates a patchwork of standards that allows substandard facilities to operate. Though Mizoram has passed elaborate legislation in the form of the Mizoram Drug (Controlled Substances) Act 2016 and The Mizoram Drug Treatment-cum-Rehabilitation Center Accreditation Rules 2019, which require accreditation of all de-addiction centers with stringent criteria for infrastructure, human resources, and documentation, implementation and enforcement are inconsistent throughout the state.30,35 Likewise, Nagaland issued the Nagaland State Drug Abuse Prevention and Treatment Policy 2016, with the State Social Welfare Department as the nodal agency, and Assam introduced a framework under several prohibition acts by the State Anti-Drugs and Prohibition Council, along with mandatory registrations under these acts.27,31
However, the remaining states in the Northeast lack such systems, opening the door for centers to practice unchecked. States such as Arunachal Pradesh and Manipur have launched and implemented policies, such as the Mukhya Mantri Nasha Mukhti Abhiyan and the Meghalaya Drug Abuse Prevention Policy, 2020. 32 Still, these policies offer no oversight of the working conditions in private rehabilitation centers. Importantly, no Northeastern state currently maintains a publicly accessible registry of all private de-addiction and rehabilitation facilities.
Toward Evidence-based Regulatory Reform
The evidence-based literature identifies several critical gaps perpetuating violations in Northeast India:
Absence of independent monitoring: Most states lack mechanisms for regular, unannounced inspections of private facilities as mandated by the Clinical Establishments Act 2010 and MHCA 2017. Rising cases of human rights violations: Cases of systemic violation of human rights and deaths inside rehabilitation centers under “mysterious circumstances” are frequently found in news headlines. Lack of qualified personnel requirements: Many centers employ staff without psychiatry, counseling, or nursing qualifications, violating MHCA 2017 Section 89 requirements for “mental health professionals.” Insufficient oversight of admission procedures: Involuntary admissions continue without the required independent medical examination by two practitioners, one being a psychiatrist. Absent or inadequate grievance redressal mechanisms: Individuals lack channels to report abuse while in facilities or after discharge. Limited coordination between regulatory bodies: The Clinical Establishments Act (health), NDPS Act (law enforcement), and MHCA 2017 (mental health) fall under different jurisdictions, creating accountability gaps.
Thus, to complement Molanguri’s call for accreditation and licensing,
4
we propose:
Establishment of a centralized, publicly accessible registry of all de-addiction facilities—governmental, NGO-operated, and private—to enable informed choice and facilitate oversight. Unlicensed private facilities can practice deceitful advertising, assuring cure rates or treatment results that cannot be supported, yet again taking advantage of desperate individuals who seek to have their loved ones treated. Mandating uniform national guidelines under the MHCA (2017) and Clinical Establishments Act (2010) for infrastructure, staffing qualifications, treatment protocols, and fee structures, with penalties for non-compliance. The unregulated status of most private rehab centers provides avenues for economic exploitation of families already burdened by the cost of addiction. Lack of standardized fees, quality measures, or outcome assessment may result in families paying high prices for services of dubious effectiveness. Without regulation, there are no consumer protections for families who may be overcharged for inferior care. Implementation of routine inspections, outcome reporting, and grievance redressal mechanisms for private centers, coupled with community-based follow-up to monitor relapse rates and aftercare quality. State-level grievance redressal boards should include at least one representative from a recovering users’ network to ensure ethics-driven, user-centered accountability. Recognition and establishment of a structured aftercare system: Comprehensive aftercare programs for individuals discharged from rehabilitation centers should involve collaboration with community-based organizations, peer support networks, family engagement, and primary healthcare providers. The absence of systematic aftercare perpetuates high relapse rates and undermines treatment gains, especially in regions with limited follow-up infrastructure, such as Northeast India
2
. We recommend mandating individualized relapse prevention planning, ongoing psychosocial support, vocational rehabilitation, and routine outcome monitoring as essential components of all licensed facilities. Strengthening community linkages is crucial for promoting sustained recovery and reducing stigma associated with SUDs. Capacity building and training: Regulatory authorities must receive appropriate training and resources to effectively develop expertise in addiction treatment standards, human rights protections, and evidence-based practices. Technical assistance programs should be established to help existing private facilities achieve compliance with regulatory standards rather than simply shutting down non-compliant centers, which could reduce access to treatment in resource-constrained areas.
Implementation Challenges and Solutions
Implementing comprehensive regulation may face predictable resistance from vested interests and capacity constraints within government agencies. Private operators may likely argue that regulation increases costs and reduces access, while some state governments may resist additional administrative burdens. However, these challenges can be addressed through phased implementation, beginning with basic safety requirements and gradually introducing more sophisticated standards.
Federal funding incentives can encourage state compliance, while technical assistance from organizations such as the National Institute of Social Defense can support holistic implementation.4,36 Central government schemes such as NAPDDR and state-level resources may need to be coordinated to cover all areas comprehensively.
Northeast India has long stood at the crossroads of vulnerability, ever since the region’s entanglement with cross-border trade routes and border disputes. With each wave of legislation and policy announcement after independence, hopes were raised that substance use in these states would be contained. This persistent challenge raises another important paradox: Despite an evolving landscape of national acts, funding schemes, and regulatory measures, Northeast India has continued to experience such high rates of substance use.
Conclusions
Private rehabilitation centers in Northeast India operate in a regulatory void that enables systematic exploitation of vulnerable individuals. Documented deaths, serious assaults, and rescues from illegal detention strongly suggest that reliance on self-regulation within the private rehabilitation sector is insufficient to protect the rights and safety of service users. While available data do not permit causal inferences about specific regulatory provisions and individual incidents, the persistence of violations despite an existing legal framework points to serious gaps in implementation, monitoring, and accountability. There is no national or state-level denominator for the number of private rehabilitation centers, no routine reporting of adverse events, and no large-scale empirical studies quantifying the prevalence of human-rights violations in this sector. India has the legal infrastructure, institutional capability, and ethical basis to tackle this crisis. Still, without decisive government action to regulate the sector, the issues will keep growing as the treatment gap widens and business interests exploit regulatory vulnerabilities.
State health and social welfare departments, accredited private providers, and civil society organizations can share responsibility for enforcement, capacity building, and adverse event reporting through a public-private partnership model. In resource-constrained Northeastern states, such arrangements can strengthen standards under the MHCA 2017 through accreditation, performance-linked funding, and transparent disclosure requirements.
The necessity of full regulation of private rehab centers is not a matter of policy choice but a human rights imperative. The cost of doing nothing will eventually lead to the erosion of public confidence in addiction treatment services. In terms of substance use rehabilitation, Northeast India’s vulnerable populations deserve dignity, safety, and evidence-based care. It is therefore imperative to examine whether current frameworks align with the unique histories and structural realities of Northeast India or require region-specific adaptations for enhanced effectiveness. The gravity of this crisis requires no less than swift, coordinated action to close the regulatory gap through state-level regulatory frameworks, independent monitoring mechanisms, and, fundamentally, a cultural shift from commerce-driven to ethics-driven addiction treatment.
Footnotes
Acknowledgements
The authors gratefully acknowledge the work, support, and insights provided by field experts and colleagues in the domains of addiction psychiatry and public health policy in Northeast India. No professional writing or editorial assistance was received.
Appropriate Permissions from the Concerned Authorities
Not applicable for a viewpoint article.
Data Sharing Statements
Deidentified individual participant data will not be made available, as this is a viewpoint article based on published literature.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Declaration Regarding the Use of Generative AI
No part of this article was written or generated by a generative AI tool. The authors take full responsibility for the accuracy, integrity, and originality of the published article.
Ethics Committee Details
This viewpoint article does not involve original research or human/animal subjects and, therefore, did not require ethics committee approval. It is a commentary based on publicly available literature and published policy documents.
Name of the Institutional Ethics Committee/Independent Review Board: Not applicable Approval Ref. No.: Not applicable Date: Not applicable
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Informed Consent/Assent
This viewpoint article does not include any individual patient data or identifiable information; therefore, patient consent was not required.
Prior Presentations
No.
PROSPERO/CTRI Details
Nil.
Registration
Not applicable for viewpoint article
Trial registry name: Not applicable URL: Not applicable Registration number: Not applicable
Simultaneous Submission to Another Journal or Resource
No.
Status of Your Study (for Study Protocol)
Nil.