Adopting Aggarwal’s institutional bargaining game approach, the present study analyzes the U.S. counter-narcotics regimes in Central Asia and investigates factors that shape the institutional design and the outputs of the regimes. Factors under examination include the existing counter-narcotics and other security-related regimes, the provision of goods and the individual situations, including the elite beliefs and domestic political situations. The study argues that the strength of the U.S. counter-narcotics regimes is undermined by the absence of a holistic approach; the lack of effective implementation; the lack of supervision; the clan-based politics and the weak state legitimacy; the lack of political will and the influence from Russia. Observing the inconsistency between the claimed counter-narcotics commitment of the participants of the U.S. regimes and actual actions of the participants, the study argues that the engagement in counter-narcotics mandate is always not the priority for the U.S. and the Central Asian states; the engagement, rather, is used as a tool to achieve the interests and goals of the regimes’ participants: to extend the counter-terrorism mission (for the U.S.) and to secure regime stability (for the Central Asian states). Different from the prior studies which merely target factors that cause the ineffectiveness of the counter-narcotics regimes in Central Asia, the present study explores the interactive effects of the factors that shape the counter-narcotics institutional arrangements in Central Asia and contributes to the understanding of the genuine nature of the anti-drug regimes.