“They are treated like trash!” – Abuses in Iran’s Rehabilitation Centers

Radiozamaneh – you’re brought there under article 16, they’d rough you up. I saw them kill a guy with my own eyes. It was four years ago in a mandatory rehab center in Khavar-Shahr. The guy wanted out, he wanted to leave, so he drank some bleach. The next day the staff found out and started beating him. They beat him so hard that he got a bleed in his stomach; not because of the bleach he had drunk, but because of the beatings he had received, and after that, he didn’t make it…”.

This is part of Reza’s story, a single 42-year old who works as a welder. He lost his father when he was 14. He is the oldest child in his family and therefore, it was considered his responsibility to take care of his siblings. The loss of his father alongside other family issues drove him, first, towards smoking, and then, at the age of 16, towards using opium.

Substance abuse disorder is not a rare phenomenon among Iranian adolescents. According to Dr. Majid Abhari, pathologist and social behavior analyst, the minimum addiction age in Iran is currently 14. In many cases, substance abuse starts with smoking cigarettes and hookah. In a report by Fars News Agency, Parviz Afshar, the spokesperson for the Drug Control Headquarters, stated that in 2018 about 2 million and 8 hundred individuals aged between 15 to 60 years struggled with substance abuse disorder, of which 10% were females.

Dr. Ardalan, physician, sociologist, and fellow of substance abuse disorder told Zamaneh that while substance abuse is a nation-wide problem in Iran, in some areas like Tehran, Mazandaran, Kerman, and Sistan-o-Baluchestan, due to higher population density, poverty, and marginalization as well as political and cultural factors, addiction rates are significantly higher.

Reza was born in Lorestan, a province where, as he tells us, smoking opium in feasts and family gatherings is an accepted tradition. His abuse disorder got worse during the years of his military service, and by the age of 20, he had become completely dependent. From 1991 to 2016, he used opium for more than 20 years. He tried to cure himself of addiction without asking for help a few times but every time he relapsed and as a result, he gave up the idea of overcoming his addiction on his own for about 15 years. After that and till 2016, he was admitted into 12 different substance abuse treatment facilities for detoxification. Some of the centers he went to were in Lorestan and some were in peripheral cities near Tehran. Of the 12 times, he was admitted some were voluntary and some court-mandated. The name of all the facilities will remain confidential as per requested by Reza. However, he agreed to reveal the name of the last center, where he finally managed to overcome his problem, and this was in a charitable facility in Tehran, called “Tolou-e-Bineshanha” (the rise of the anonymous).

The present article is the result of long conversations with former drug users, experts and researchers of the field, as well as a thorough study of the existing research on conditions of the patients in substance abuse treatment facilities. Of the 9 former users who have been interviewed, 6 have personally experienced different forms of physical and mental abuse during their stay in mandatory treatment programs; such as beating, being thrown into freezing cold pools, and verbal or emotional abuse. Some have even claimed to have witnessed the death or suicide of their peers in the centers. The 3 interviewees, who don’t have any personal experience of violence, have not received treatment in any facility, but have received help from charity groups as outpatients, or have been assisted by doctors, psychologists or peer support groups. It appears that undergoing violence is common in such facilities as other experts and published articles also show.

The present article is the result of an investigation into substance abuse treatment facilities in Iran and their relations with the law and the legal system, governmental, and non-governmental organizations. The article has sought to answer the following questions: Are the patients in rehabilitation facilities falling victim to physical and mental violence? What do their experiences at such centers reveal? Are these facilities being run by the government?
The method used for the present research is qualitative. Some candidates have been chosen using a snowball sampling (chain sampling) technique. Others have responded to invitations posted on the author’s social media accounts. Some interviews have taken place over the phone and some in a written format. Books, published articles, and reports from official websites inside and outside Iran have also been used as sources for the present article.
For the investigation, Zamaneh’s journalist Nasim Roshanai has interviewed 13 individuals, of whom 9 are former drug users and 8 currently live in Iran. 4 other interviewees were experts and informed persons. All names used for the participants are fake, with the exception of Solmaz Eskandarzadeh, psychologist, who has given us consent to use her real name. A general physician, interviewing under the alias Dr. Zakaria, a physician, sociologist, and fellow of substance abuse treatment under the alias Dr. Ardalan, and a journalist under the alias Sharifi, are the experts who have been interviewed during the course of the research. Some former users have requested that the names of the treatment facilities remain confidential and in some cases, names were already forgotten. Notwithstanding all of the above, the present article does not claim to reflect the experiences of all patients in every and all substance abuse treatment facility in Iran. 

Experiencing physical violence in rehab centers is a given

According to number 10, note 2, article 77 of the Foundation, Management, and Supervision Act for governmental and non-profit organizations active in substance abuse treatment and damage control (passed 31 October 2010 in Expediency Discernment Council), practising any kind of violence against patients is against law and will result in revocation of the license and termination of the activity of the center.”

Although practicing violence is illegal, it happens all the time. According to an Etemad Newspaper report, back in October 2016, Omid, 42, who was admitted to a rehabilitation center in the east of Tehran, called “Rahjouyan-e-Rah-e-Rahai”, passed away after 13 days of residing in the facility. Clear signs of beating were visible on his back and shoulders. This rehabilitation center was active without a valid license. Further investigations revealed that all the patients at the center, upon their admittance and during the first days of detoxifications, were subjected to severe physical violence. Also, some chains were found on the premises which were used to restrain the patients. Apparently, the staff hung the patients from a wardrobe during the beatings.

Reza is one of the interviewees, with whose story the article opened. He has personally experienced severe beatings, being thrown in a pool of freezing cold water, and other forms of physical and mental abuse in rehabilitation centers. Zamaneh asked him for a medical certificate or any other document that could support his story, but he was not able to provide one. He says what he has personally undergone is nothing compared to the things he has witnessed at some centers.

“There was this really big, strong, muscular guy. I remember seeing 10 members of the staff attacking him at the same time, beating him up and breaking his limbs. I have seen members of the staff stabbing the addicts or breaking their noses. There was this guy who couldn’t take it anymore. In front of my very eyes, he poured gas on his head and took out his lighter. Later they told us that he had died. This was in Doroud, in Lorestan province.”

Hasan, 40 and single, is another former drug user, who lives in the vicinity of “Darvazeh Qar”, a neighborhood in Tehran. From the age of 14 and for about 20 years (from 1993 to 2013) he used various substances such as opium, hash, alcohol, crack, meth, and heroine, and during the course of these years, he underwent detoxification 15 times. Hassan’s father passed away when he was 19 and as he tells us, his drug abuse became worse since then. He was even incarcerated for minor theft and drug abuse once. One of his brothers overdosed and died in his arms. He says his dependence got so bad that for a few years he had to sleep on the streets around his childhood home.

He has been sober for 6 years now and he has a job at a restaurant. The last place where he sought help to overcome his problem was “Tolou-e-Bineshanha”, a non-governmental, nonprofit organization that was founded in 2009 with the aim of rehabilitating socially afflicted women, men, and children. This organization specializes in and offers help to individuals struggling with homelessness and is active in different areas such as housing, treatment, sheltering, education, employment, and reintegration into family and society.

Hassan has kept in touch with “Tolou-e-Bineshanha” ever since. When Reza came to this center for treatment, Hassan was already there and helped him along his way. According to Hassan, they have repeatedly shared their experiences of physical and mental violence. Zamaneh asked them for any kind of document that can verify these abuses, but they were not able to provide any. Hassan’s experience, like Reza’s, includes beatings, freezing cold pools, and other types of physical and verbal abuse, not to mention he has once actually undergone torture.

Hassan told us the story of a center where he stayed in 2005. This center was located in an industrial area outside Tehran. The center was called “Hami20”. It was shut down and is not active anymore. We tried to contact the Welfare Organization (Behzisti) to find more facts about this center, but they refused to give us any further information. Also, Zamaneh was not able to find the name of any company or organization, officially registered under its founder’s name. 

According to Hassan, the director of this rehabilitation center, whose name will remain confidential, was himself a former patient, and he was operating under the supervision of the Welfare Organization and another organization called “Tavalod-i-Dobara (Rebirth)”. This is another NGO whose goal is to increase the life quality of drug users-regardless of their being in treatment or not- and their family members. The founder of this NGO was Forouhar Tashvighi, and it has affiliate centers in Tehran, Shiraz, Mianeh, Sanandadg, Tabriz, and Sabzevar.

Hassan tells us he wanted to leave the center, but the founder’s partner wouldn’t let him. Finally, after struggling for 9 months, he got what he wanted and left the facility; but there was a price to be paid for his freedom:

“They tied my hands behind my back, put a stick between my knees and then tied my hand to the pole. I was like a seesaw. One of them would give me a push with his foot and the others beat me with sticks on my back and legs. My soles were all blistered and I couldn’t walk for a long time after I was discharged.”

After torturing him, they kept him at the center for another two weeks, to give his wounds and bruises time to heal. He spoke about other types of physical violence:

“Centers usually keep dogs and sometimes, they’d tie the patients a few paces from the doghouse. Sometimes they’d throw us in freezing cold pools and afterward, beat us with a special kind of tube, which is very painful but doesn’t leave any marks or bruises.”

Siamak, 50, is from Tehran. He was a drug user from 1991 to 2013. He is from a high profile family and says whenever a center’s staff found out about his family, they would treat him with respect. He is divorced and has two children. A while after his divorce, he left his house and spent about 10 years of his life sleeping on the streets. During his 23 years of struggling with drug abuse, he was continuously in and out of different treatment facilities. As per his request, the name of the facilities will remain confidential. Zamaneh asked him for any document that can verify his stories from the centers, but he was not able to provide one. He has been sober for five years now and works in the substance abuse treatment field. He is yet another patient who has been able to overcome his problem with the help of “Tolou-e-Bineshanha”, just like Reza and Hassan. However, he tells us about the violence he has experienced and witnessed:

“They beat us with cables, hoses, and tubes; tubes that inflict a lot of pain but don’t leave any visible marks. They would not hit the patients in the face unless they are sure they have no friends or family that would come looking for them. Those poor patients were beaten to death and sometimes they’d bury them right there afterwards. But the situation was different for some patients; they tried to beat them in a way that would leave no marks so that they could not sue them or press charges later.”

Darioush, 55 and a resident of Tehran, is another patient who has spoken to Zamaneh. He is divorced with children. From 1988 to 2018, he used drugs for about 30 years. He was admitted into treatment facilities, either voluntarily or forcefully, 6 times. He has even been in “Kahrizak”. The other facilities will remain anonymous as per his request. His experience of mandatory treatment is mixed with stories of physical and mental violence. One of his family members has verified the prevelance of violence at the centers. Finally, last year he went to a methadone clinic and with the help he received there, he managed to overcome his problem. He now uses opium syrup daily. He told Zamaneh:

“Patient treatment at the facilities is horrible. Swearing, beating up and abusing patients happens all the time, although they have no right to treat them like that. The first days of detoxification are hard and you’d want to leave, but they’d restrain you, beat you, and throw you into cold water. Mandatory treatment facilities are the worst. I’d rather go to jail than go to one of these centers. There, you are not regarded as a human being.”

In a video published in 2018 on Rokna.News, patients at a center in Langeroud, Gilan were seen being beaten up by the staff. According to Information Center for the Charitable Organizations in Iran, this center was called “Tark-e-Etiad:Gam-e-Aval-e-Rahai, Langroud” and it was officially registered in 2011. 

Male patients are not the only victims of such violence. Nastaran, a mother of two, is 39 and lives in Malard, Karaj. She struggled with drug abuse from 2006 to 2017, but she has been sober for the past three years. Her parents got divorced when she was a kid and her father left the country. Nastaran used to live with his mother and sister. She was still a teenager when her mother passed away and she and her sister had to make it on their own with the help received from relatives. From 2011 to 2016 she experienced different treatment programs in different facilities all accompanied by violence. We also asked Nastaran for any document that verifies her stories but she had none. Though, in a different interview, her sister verified the use of violence against her at the centers.

I last talked to Nastaran a few months ago. During the course of the research I found that she has been incarcerated for a financial misdemeanour, but she has been proven not guilty and will soon be discharged.

This is part of what Nastaran told Zamaneh about her experience at the center:

“They’d shave our heads, strip us naked in the garden in freezing cold winter, and they’d splash water on us from the garden hose.”

Nastaran has stayed in different centers, sometimes voluntarily and sometimes with a court mandate. In 2014, she was arrested and sent to a center that she calls “Saba”, in Malard, Karaj. She was kept at this center for 3 years. She gave us the name of one of the directors of the facility and we were able to find the facility’s complete name. It is called “Navid-e-Rahai-Saba-Malard” and is located in Malard, a small city to the west of Tehran.

In an article published in 2014 on Salamat News, a former patient of this center who was admitted there by his/her family in 2010, talked about the experience of staying at this center.

“They chained me up in a doghouse and would sometimes spray me in the eyes with pepper spray. I underwent the worst physical and mental tortures during the 18 days I spent there, and they wouldn’t even allow me visiting hours with my family. After 18 days, they transferred me to a cattle yard down the road to the cemetery and kept me there for another 15 days, after which they would finally let me go.”

According to the same article, this unauthorized center was finally shut down in 2014. Although, the founder of the center later managed to attain a license to open another treatment center. According to the Official Newspaper of the Islamic Republic of Iran, overseen by the Judiciary, this center was officially registered as a nonprofit organization in 2014, under the name “Navid-e-Rahai-Saba-Malard”. Again according to the same newspaper, it was only after 4 years had passed that the Welfare Organization granted them permission to work in the substance abuse treatment field. This means when Nastaran was staying there between 2014 and 2107, the center was working without the necessary permits and was not authorized by law to treat patients. It is worth noting that drug users who were arrested on the streets because of “public substance-using” were brought to this center by the police.

This article proves the violence Nastaran underwent at this center is one of the thousands of similar cases.

Nastaran is rather calm and composed while telling her story as if her experience is nothing to be surprised at. She also speaks fondly of the manager of the center and says she owes her staying sober to this person’s mental support. She says about her punishments at “Navid-e-Rahai-Saba-Malard”:

“The staff used a mixture of lukewarm water and black pepper. One of them would tell me to open my eyes, would spray me in the eye with this mixture and then command me not to blink. Then she’d prod me repeatedly, bidding me dance. “Dance! Not like that! Dance beautifully!” she’d say. We were allowed into the physics room only after we were whipped five times with a hose.” The physics room is the rehab slang for the detoxification area of a facility.

I asked Nastaran what she was punished for and she said:

“They’d do it to anyone who was sent there for court-mandated treatment. It was not like we had done anything wrong. They used to say we are fighting your illness. We want to beat the illness out of you and make you come to yourself. The director him/herself would not beat the patients but delegated it to the staff. I also witnessed the staff beating the patients up without the director’s orders. But when she/he found out, it was already done, so he would turn a blind eye.”

Those who are admitted voluntarily, will not be beaten up. This fate only awaits those who have been arrested or admitted forcefully by family members. Nastaran says:

“They wouldn’t beat up the conventional patients. They are the patients admitted by their families who pay the centers to keep them there. So, they wouldn’t beat them unless instructed to do so by the families.”

In another report published by Irna News Agency in 2018, Ismael, one of the patients, talked about his experience at the centers: “It happens often that the patients die or become paralyzed at these centers. They once broke my finger. Hoses and chains are normal household objects there. Things that they do to the patients during the first days would blow your mind. They don’t just torture your body; they torture your soul.”

Solmaz Eskandari, a psychologist, who has worked in a center near Chitgar in Tehran, explains her own experience of the violence practiced at the center for Zamaneh:

“Treatment methods used for mandatory treatments were generally punitive and often accompanied by violence because the patients did not cooperate. They were usually restrained and treated violently.”

I asked her if she had ever been an eyewitness to any such violent behavior. She replied:

“The center where I worked had a security department, and if a patient tried to run away, they would beat them relentlessly. I remember this particular patient who was badly beaten up because he had caused some damage to the properties of the center, maybe breaking a window… I’m not even sure if he survived the beating. These patients are usually very weak and can’t defend themselves. Beating them up was a daily ritual. They’d tie them to beds and deny them food for a whole day as a form of punishment. Another punishment was not letting them use the bathroom. They were constantly verbally abused. They would lock them in a room for days on end, isolated and without visiting hours to see their families. Although, many of them didn’t actually have anyone… maybe a friend or two who were in the same conditions as themselves and they were not allowed to come to visit. Those in mandatory treatment didn’t have visiting hours for the first three months. That’s why they would generally try to run away.”

You wouldn’t try to run away unless you have a death wish

Forcing someone into treatment does not seem rational, as the experts claim chances of success are particularly low in such cases. Nevertheless, more often than not patients do not go to treatment facilitates of their own free will, but are either admitted forcefully by family members or arrested and sent to a facility by a court mandate.  

On the other hand, patients that are forcefully admitted experience such violence that they very often try to flee, although in every escape attempt they risk death. The least punishment for a runaway is severe physical payback.

This is what Siamak had to say about escape attempts:

“It happens very often. Although, if they catch you, they’d burn you at the stake. The worst punishments were reserved for the runaways. They’d tie them to something like a cross, only with their hands above their heads, totally naked. Or they’d wet them and leave them in freezing cold temperatures, sometimes beating them while the others were watching to teach everyone there a lesson. Sometimes they threw them in frozen pools. They say junkies have 9 lives and they would not kick the bucket that easily. This happens in all the centers. If you break the rules or try to run away, they will beat you up good. I remember a night in a center in Varamin. The patients started a riot. There were 13 or 14 of them and even though they had sticks, they didn’t manage to run away. The staff took their sticks away, tied them up in the courtyard and whipped them for days on end so that the others wouldn’t dare start a riot in the future.”

Nevertheless, it happens sometimes that the patients manage to escape. Hassan remembers seeing one of his fellow patients escaping in the director’s car.

According to the same report by IRNA, Ismael who has been to a treatment center twice, once voluntarily and once forcefully, says:

“This is an ordinary daily scene in my city. I myself have seen several runaways trying to escape the center’s staff who were after them.” The city where this center is located is in one of the southern provinces of Iran, although the name of the city was not mentioned.

Servant, middleman, Barabbas: What does each of them do?

What are the job descriptions for staff members at such centers? Are they supposed to serve and help the patients? Nastaran points out that in many centers, when patients are in pain and need help, the staff would not do anything for them. The other interviewees also confirmed unanimously that no help or service was offered to the patients by the staff.

Although physical conflicts might happen between the patients of a center, the systematically organized violence that is practiced is carried out by the staff and the middlemen. In some centers, the staff is called “servants”, and executing physical punishments and controlling violence at the center is a part of their job description.

Also, sometimes particular patients at the centers are authorized by the director to resort to violence. In some centers, such patients are called “middlemen”. A middleman has the same role as a monitor in a classroom, with the difference that he is authorized to control and punish his fellow patients by the use of violence. In other words, they carry out the same duties as a servant, but they are always present among the patients and can act immediately when the need arises.

Hassan has been a middleman at a center once, and he has beaten up a fellow patient, and he regrets it deeply. He says about middlemen and their duties:

“Like every prison that has its own bully, every room in the center has a middleman who helps the manager run the center. They’d give him a few privileges and a couple of newbies. If someone wants to make trouble, the middleman and his newbies, even the other patients will put him in his place. I was once a middleman and beat someone up really bad. Maybe I was suffering from delusions of grandeur.”

Alongside the staff and the middlemen, there is a third group whose job is forceful admittance of the patients. According to Dr. Ardalan, after numerous centers were founded but patients were not willing to go there for treatment, a number of strong and muscular members were added to the staff who are called by different names in different areas. In some parts of the country, they are called “Barabbas” and they are responsible for transferring patients to the center by using force. He says:

“Some centers, many of them unauthorized, would add some muscular, robust members to the staff and they’d call them “Barabbas”. Sometimes patients turn psychotic because of using methamphetamine. That’s when the Barabbases step in and literally drag them to the center for admittance. It is not uncommon for the Barabbas to beat up, torture, or even sexually abuse the patients. We have even had cases where extreme violence has resulted in the death of the patient. Having this addition to the staff is more common in some cities than others; for example, there was a time when in Kermanshah centers complained that Barabbases from centers in Lorestan come to their centers and take their patients away. “

Apparently, finding a Barabbas is not even that hard. According to Dr. Ardalan, you can find them online, or search for their phone numbers written on the walls outside Tehran.

In the same report by Irna News Agency, Amir, a counselor at a center where he was responsible for giving support to traumatized patients, said about the centers’ conditions in the southern parts of the country:

“Believing what some patients had to say about centers was difficult for me for a long time. It sounded like Guantanamo … I remember one of them saying he was chained to a tree for two days upon the arrival. When they first arrive at the center, they have to spend two days in quarantine, and only after that, they will be able to start detoxification.”

He also added:

“Arresting and admitting the patients is quite a story in our city. Just to give you an example, I remember this center who had employed a person called Malek. He was in charge of tracking down and bringing in the patients and this entailed a whole lot of surveillance keeping and man-hunting. I have met Malek, he is very tall, about 6.2, and very muscular.”

Amir adds:

“Rumor has it that he has even traveled as far as Shiraz to bring back patients. Although, if he needs to leave town, he’d take a few guys along with him. It takes five hours to arrive in Shiraz from our city. Just like a professional police officer, Malek would go to the surrounding cities and look for a specific person for days, and when they finally fid him, they’d shackle him and bring him back.”

According to this counselor, since every patient means new income for the center, they are willing to go to extreme lengths to hunt new patients.

Why are the patients treated violently during the course of treatment? Amir answers our question:

“At first it may seem they are trying to open the patients’ eyes to see things clearly, to make them comprehend the situation they are in and hopefully, turn a new leaf. But the more time passed, the more I understood this abusing and torturing the poor defenseless drug abuser is a question of dominance and power. Pleasure they draw from these acts of violence, dominance over the addict’s body, and financial expediency are the three corners of a horrifying triangle, and if the authorities don’t recognize this problem soon and they don’t find a solution in time, this can turn into a disaster, not to mention the fact that for the past decade addressing drug abuse problem and its treatment has already been quite a challenge for the country.”

What is going on in government-controlled, private, authorized, and unauthorized treatment centers?

Nowadays, there are many different types of substance abuse treatment centers in Iran; centers whose structures and functions have undergone drastic changes over the years. In an article published by Fararu News Agency, Ali Shafiei, an expert in substance abuse studies and a member of the Iranian Sociological Association says:

“Treatment centers, as we know them today, were first established in 1991. The treatment was based on peer support methods, and the centers were usually founded by former drug users who had been sober for a while. They would keep patients isolated until the detoxification process was complete, after which they would be introduced to group therapy sessions. The patients spent 21 days at the center for detoxification and therapy. These centers were nonprofits and were run by volunteers.”

According to article 15 of the Drugs Control Act passed in Expediency Discernment Council, drug abusers are obligated to seek treatment. A note to this article compels the development of a bylaw for damage control and treatment. In this bylaw, treatment centers are foreseen by the legislator (the image below)**.

With the exception of therapeutic centers, all other centers that admit patients for long-term treatments (1 month and more), are either private nonprofits or charitable organizations. Although, if a patient is mandatorily sent to a private center by the Judiciary, the center will receive a daily budget per such patient. According to a Young Journalists Club report and as claimed by Eskandar Momeni, Secretary-General of Iran’s Drugs Control Headquarters, in 2018 the per-capita for the treatment of each addiction patient was between 15 to 20 thousand Tomans daily.

The UNODC (United Nations Office on Drugs and Crime) has an active field office in Iran which supervises and cooperates with substance abuse treatment centers. UNODC and the Islamic Republic in Iran signed a country partnership program in 2015 to enhance drug control. The budget assigned to this program was about 20 million US dollars.

In another similar act in 2018, the European Union assigned an 18-million-euro budget to Iran, a portion of which was supposed to be spent on drug control and substance abuse control in Iran. According to the same report, another 8 million dollars was allocated to the UNODC by the EU. I tried contacting UNODC ‘s office in Tehran to ask some questions in this regard, but they refused to talk to Zamaneh.

Tayebeh Siavoshi Shah-Enayati, PM, in an interview with Salamat News, announced that in 2017, 30 different organizations were allocated budgets for drug abuse control and treatment, and collectively received about 300 billion Tomans for that aim.  

Despite all the financial aids that have been received from the EU and the UNODC, and notwithstanding the 300 billion Toman budget allocated by the government, no changes have been made to improve the conditions of treatment centers. According to Tayebeh Siavoshi, the little improvements we witness are thanks to NGOs and nonprofits rather than to the government and the authorities.

I asked Dr. Ardalan if UNODC oversees and controls the centers’ activities in Iran. He answered:

“I’m sure they are aware of the violations at least to some extent. But Iran and the Western world have been engaged in this blame placing game for years, where Iran claims to be combatting drug trafficking and drug abuse single-handedly and accuses the West of not assisting. They receive different monetary and non-monetary aids and some people work really hard in this field. But the truth is, this money and energy is being spent on combatting the addicts/patients, not the causes of the illness and the conditions of the centers are a clear sign of that.”

Although according to the aforementioned bylaw, medium-term treatment centers are required to use professionals such as physicians, psychologists, and trained nurses, according to Dr. Ardalan, in reality, this is not the case. Many times in centers where the presence of a physician is mandatory, their presence is only a formality and they have no active role in the treatment process.

The patients I interviewed confirmed Dr. Ardalan’s allegations. Except for a few government-controlled centers and private NGOs like “Tovalod-i-Dobara” and “Tolou-e-Bineshanha”, which avail themselves of the services of professional caretakers, they have never set eyes on a doctor or a psychologist at other centers.

Nastaran has been to both government-controlled and private rehab centers. One of the places where she has been treated with respect and received adequate medical and psychological care, was in a center called “Madar (Mother)” near Chitgar, in Tehran. According to her, this center worked under the supervision of “Tavalod-i-Dobara” and had its own set of rules. They had a psychologist and a lot of different rooms where clean and comfortable. Her worst experience was in a private center that was finally shut down due to the directors’ negligence.

Granting all this, the practice of violence happens in both government-controlled and private, nonprofit centers, with the private centers winning the first place for such malpractices.

The interviewees have defined the private treatment centers as unprofessional, overpriced, negligent of the patients, unruly, occasionally with unnecessary extravagances and lacking standard medical and psychological care.

Some authority figures have occasionally admitted to and confirmed the disastrous conditions of the treatment centers. Hassan Jahanshahlou, the attorney General of Fardis, published two pictures of treatment centers in 2018 on. According to Isna (Iranian Students News Agency), Jahanshahlou wrote online that he and two of his colleagues paid impromptu visits to two treatment centers in the province and took some pictures during their visits. He wrote:

“These are pictures [presented below] from centers that are allegedly amongst the best in the province! The pictures on the left show a place that would barely qualify to be used as a cattle yard and yet, the Welfare Organization has issued a license for substance abuse treatment center for this place. And the other center that I personally visited resembles a Nazi forced labor camp. Patients work from 9:30 am till 11 pm sitting on cold mosaic floors, assembling carton boxes. They have 20 beds and more than 120 patients whom they are clearly exploiting as a free workforce.”

Although the Welfare Organization is the authority responsible for issuing activity licenses and overseeing the activities of such centers, having obtained a license does not always mean the required standards are met. Also, some private treatment centers are unauthorized and work without a license. These are the centers with the most violent approaches and poorest medical facilities.

According to Irna (Islamic Republic News Agency), the number of unauthorized centers has increased significantly during the past few years. There have been allegations of physical and mental violence, as well as torture in the centers. Also, according to the same news agency, the further we go from the capital, the more likely it becomes to encounter inhumane, critical situations at the centers. According to Parviz Afshar, the spokesperson for the Drugs Control Headquarters, the number of authorized centers is between 1,200 to 1,300 and the rest are all unauthorized.

7 years ago, Yousef Doulati, director of a treatment center called “Afaq-e-Mehrandishan”, in an interview with Fararu News Agency said:

“Whereas only 51 centers in the country have a valid license and treat substance abuse in a professional manner using peer support groups, group therapy sessions, training courses for Matrix Model treatment, and group sessions for family members, there are more than 500 unauthorized centers that work without a license issued by the Welfare Organization.”

Sharifi, a journalist, also talked to Zamanh about unauthorized centers:

“There are many unauthorized centers out there. Some individuals manage to open a center because they have someone willing to pull the strings for them. Many of them are related to high profile families, like the mayor, PMs, a member of the Guard Corps, or a high profile manager. More than often these so-called founders and managers are lawbreakers themselves. They move their centers to the suburbs, where there is less supervision and they can act more freely. Torture, sexual abuse, and death are not uncommon in these centers.”

Some of the interviewees have had the experience of staying at centers located in the peripheries of the city. According to them, the further the center is located from the city, the more the patients are subject to violence. Also, such centers usually have poorer facilities.   

Dr. Ardlan confirmed this, saying:

“It’s easier to break the rules and abuse the patients in the suburbs. The police and the Welfare Organization show less interest in these areas and that is a good reason to move a center somewhere farther where it does not get much attention. But sometimes these centers are legitimate and helpful, but they are forced to move outside the city because generally, such organizations are not welcome in many neighborhoods.”

As long as you are an addict, you are a criminal

“It was back in 1980, when I was passing by Imam Hossein square, that I saw some people being publicly beaten up on a temporary stage. They were drug addicts and this was my first encounter with a phenomenon called drug addiction.”

Dr. Zakiria told Zamaneh he had witnessed this scene when he was only a teenager. Later, he helped many patients struggling with substance abuse in his own office in Karaj.

After the Islamic revolution of 1979, the new regime adopted a rather harsh approach towards drugs and substance abuse control. According to a report by Said Madani Ghahfarokhi, author of the book “Drug Addiction in Iran”, the revolutionaries were of the opinion that Imperialism uses opiates as a weapon to dominate the third world countries in all aspects namely economic, political, and cultural aspects. Although, before the revolution and during the reign of Pahlavi dynasty, the Opium Poppy Cultivation Control Act was passed in 1945, according to which drug users were obligated to seek treatment within 6 months.  

Rouhollah Khomeini, the founder of the Islamic Republic in Iran, in 1980 and in a meeting with representatives from different groups of people, said:

“The youths who spend time in brothels, don’t care. The youths who are stupefied by opiates, don’t care about what is going on in their country. We want to free our youths from the bong and bring them to the battlefields, (but) you want us to let go of them so your lords can exploit them.” (Mohammadi, 47:1382)

After the revolution, those in power were of the opinion that drug abuse disorder was a counter-revolutionary behavior that the colonialists encouraged to destroy Islam and the Islamic Revolution and therefore, they thought it their duty to put an end to it with harsh preventive and punitive laws and regulations.

The first legal action that evinced this ideological stance, was the appointment of Ayatollah Khalkhali in 1980 as the director of the Drugs Control Headquarters. Khalkhali, who was an ecclesiastical judge practicing in Islamic Revolutionary Courts, was appointed to this position by Dr. Banisadr.

Aslan Zarrabi, psychologist, in an interview with Ghahfarokhi, said about the violence practiced against drug users: “Resorting to violence is a common strategy for fighting drug addiction. Many countries, including China, use such violent approaches (including execution). In our country, such measures were used during the Shah regime, and during Mr. Khalkhali’s responsibility they continued…”

According to Saeed Madani, in 1980 and in a meeting[1] on the subject of drugs control, in addition to measures for controlling drug trafficking, some decisions were made regarding drug users: the police was obligated to arrest addicts and homeless people all over the city and transfer them to centers especially established for this purpose. Since then, addiction is considered a crime. The laws and regulations governing drug abuse have been amended a few times and some notes have been added to the previous articles.

Although from a scientific point of view drug addiction is an illness, after almost forty years of passing and amending rules and regulations and adding notes and articles, still today the drug user who has not decided to seek help and treatment to overcome his problem is considered a criminal by law. 

This ideologically based criminalization of an illness called drug addiction has even penetrated the public perception of this illness. The pain and suffering families go through when a member of the family struggles with addiction is completely understandable, but denying his/her illness, hiding it, abandoning the patient or condemning him/her and calling them a shame to the family are all signs that families, as well as authorities, tend to forget the illness factor and the reasons that have caused the illness.

All the interviewees unanimously confirmed that during the period they struggled with addiction, they were constantly insulted, abused and put through suffering by family and by the authorities. Siamak told Zamaneh that drug abusers are treated like animals in this country.

Solmaz Eskandari also believes that drug abuse disorder is mostly considered a crime and not an illness. She tells us about the center she worked in:

“At the center where I worked the staff called the patients parasites of the society. They told them that their families didn’t want them either. They told them: ‘We took you off the streets and gave you food and a place to crash. You have to be grateful you have nothing else to do but to eat and sleep’.”

Dr. Ardalan believes the society uses drug addicts as scapegoats and blames them for other problems the society is struggling with. He believes they try to avoid taking responsibility and they want to wipe out the question instead of trying to solve it.

Drug abuse disorder has different social, economic, and psychological causes which are all being neglected when it comes to rulemaking. If the lawmakers address these problems with proper policies, addiction rates will also decrease. Dr. Ardalan says:

“The Welfare Organization and the Ministry of Cooperatives, Labour, and Social Welfare nor want neither can support these patients. Even within these organizations, these patients are being discriminated against. They don’t receive any help from Imam Khomeini Relief Foundation, either. As if they are less than a human, more like animals. The Welfare Organization prefers not to have its own target group within its sights.”

During my interview with Reza, he repeated time and again that patients struggling with drug abuse disorder are always labeled as criminals and outlaws. He says:

“In Iran, drug addicts are not actually considered patients. They use the verb “collect for them instead of “organize”; as if they are trash. I know these are just words, but words have specific connotations and there is always more to a word than meets the eye.”

Khalkhali, after his appointment on 10 June 1979, wrote in Ettela’at Newspaper and the Islamic Republic Newspaper: “The great Muslim nation of Iran should be aware that when the international Imperialists and the world-devouring Zionists couldn’t bend the iron willpower of our nation and our great leader, they smuggled tens of thousands of kilos of heroin, opium, and hash into our country to do away with our youths so that instead of reconstructing their native land, they would loll on the streets waiting for the nefarious white dust. But with our great nation’s will, we rose above and fought back this home-wrecking deluge and we need your help to continue this fight. We will not let them … the great country that wiped out the notorious Shah regime, will be able to wipe out its corrupted, parasitic customs as well and this is the irrevocable decision of our nation.”

This meeting was held with Ayatollah Khalkhali, Mirsalim, deputy to the Minister of Interior and Head of the Police Force, the head of the Supervision Committee on Drugs Control in Ministry of Health, the heads of Drugs Control departments in Police Force, authorities from the Ministry of Interior and Tehran’s Central Committee in the Ministry of Interior.

* Visualizations by Payam Elhami

Sources:

Madani Ghahfarokhi, S (2011). Addiction in Iran, Sales Publication, Tehran, Iran

Ghiabi, M (2019).Drugs Politics, Managing Disorder in the Islamic Republic of Iran, University of Oxford , University Printing House, Cambridge CB2 8BS, United Kingdom, New York, USA