Reviewed byTimur Abdrakhmanov, MDPsychotherapist · updated 11.11.2026
Key facts
- Who provides care
- an addiction physician or psychotherapist trained in motivational interviewing; a psychologist counsels the family
- Where
- at the clinic in Almaty, at the patient’s home, or by video call; you can start with a family-only consultation
- Duration
- one session lasts 50–90 minutes; usually 1 to 5 sessions are needed
- Anonymity
- sessions are anonymous, with no registration at the state dispensary, and what is discussed is protected by medical confidentiality
- When it is urgent
- a binge that threatens health, psychosis, aggression, or talk of suicide — call 103 or 112
- Outcome
- the person agrees to an assessment, detox, or a treatment program — or at least to another session
What to know
The most common call I take as a doctor in Almaty goes like this: “He knows he drinks, but he refuses treatment.” Sometimes it is a husband who “unwinds” every evening after a day at the office on Dostyk Avenue; sometimes it is an adult son, a programmer, who is sure he has everything under control. Persuasion, tears, and threats usually only strengthen resistance. Motivational work takes a different approach: the specialist does not argue or shame, but helps the person see for themselves the gap between how they live and what they want.
The main method is motivational interviewing, an evidence-based approach included in WHO and NICE recommendations for working with alcohol and other addictions. It takes into account the stages of readiness for change: from “I don’t have a problem” to “I want to do something about it.” The goal at Akalam is not to “persuade at any cost” but to help the person move to the next stage. We are honest about this: an adult cannot be treated against their will, and involuntary treatment is only possible by court order under the procedure set out in Kazakhstan law.
When Motivational Work Is Needed
- the person admits they drink or use a lot but says “I’ll quit on my own”
- they agree to an IV drip but refuse any further treatment
- after every relapse they promise to change but never go to a doctor
- they react with aggression or hurt to any conversation about addiction
- they are torn: they want change but fear exposure, losing their job, or withdrawal
- they have been treated before, relapsed, and now feel ashamed to seek help again
- the family is tired of pleading and does not know what to do next
If life is at risk — loss of consciousness, seizures, hallucinations, overdose, suicidal thoughts — call 103 or 112. Helpline for children and young people: 150.
Why People Refuse Treatment
Denial in addiction is not stubbornness or lying in the usual sense. It is a psychological defense: admitting the problem means admitting that alcohol or drugs are stronger than you, and that is frightening. Add to this shame, fear of being put on the state registry, and worry about losing a job or a driver’s license. In a big city where every other acquaintance has Friday get-togethers, it is easy for a person to convince themselves they are “just like everyone else,” and hard for them to notice the difference.
Motivation does not come from pressure — it grows when a person feels heard and respected in their right to decide. That is why motivational interviewing works better than ultimatums. The specialist asks open questions, reflects back what was said, and reinforces the person’s own arguments for change. How the family behaves also matters: consistent boundaries without shouting help more than endless fights.
How a Motivational Consultation Works
Most often, we start with an online consultation for the family: we find out what is happening, what has already been tried, and how the person reacts when the subject comes up. Then we decide together how to suggest a meeting — without deception or ambushes. The conversation itself takes place at the clinic, at home, or by video: the specialist asks about the person’s life and what worries them, and invites them to weigh the pros and cons. If they show readiness, we immediately discuss a concrete step — an assessment, detox, or rehab.
A motivational conversation is not held with someone who is heavily intoxicated or in severe withdrawal — medical care must come first. In cases of psychosis, aggression that threatens others, or suicidal thoughts, call 103 or 112 immediately. We do not come to “take” a person by force, slip medication into their food or drink, or suggest tricking them — this is illegal and destroys the trust that treatment depends on.
How we help
Motivational Interviewing
A structured conversation in which the specialist helps the person put their own reasons for change into words. It uses open questions, reflective listening, summarizing, and work with ambivalence. Crucially, the decision is made by the patient — which is exactly why it tends to last longer than agreement given under pressure. The approach is described in WHO recommendations on brief interventions.
Consultation With an Addiction Physician
Many people agree to talk not to a psychologist but to a doctor — “just to check my health.” The addiction physician explains in plain language what is happening to the liver, heart, sleep, and memory, and answers questions without scare tactics. Objective medical information, especially with lab results, often becomes the argument the person is ready to hear.
Family Work
The psychologist teaches relatives to talk about the problem calmly using “I” statements, to stop covering up the consequences of drinking or drug use, and to set boundaries. Elements of the CRAFT approach are used, which is designed specifically for the loved ones of someone who refuses treatment. A change in the family’s behavior often sets off change in the patient as well.
A Short Plan for the First Step
When the person agrees, it is important not to let the moment slip. We immediately offer a specific, manageable step: an assessment, lab tests, a consultation with a psychotherapist, or detox. We discuss practical matters — sick leave, vacation time, who will look after the children, how to get there from Talgar or Kaskelen. The simpler the first step, the more likely it is to be taken.
How treatment works
- 01Call or WhatsAppThe administrator and the doctor on duty clarify the situation and tell you what to do right now.
- 02Examination or consultationThe doctor visits your home, sees you at the clinic or joins by video.
- 03Treatment planWe choose the format — at home, inpatient, psychotherapy or rehab — with a clear price.
- 04Ongoing supportYour doctor and psychotherapist stay in touch: follow-ups, family support and relapse prevention.
Myths and facts
MythNothing can be done until the person wants it themselves
FactThere is no need to wait for “rock bottom.” Motivation changes under the influence of conversations, the family’s behavior, and information about health. Motivational interviewing is designed precisely for people who are not yet ready, and relatives can start working with a specialist before the patient does.
MythYou can treat a person without their knowledge
FactSecretly adding medication to food or drink is life-threatening and illegal. Adults are treated only with their informed consent; involuntary treatment is possible only by court order under the procedure set out in Kazakhstan law. Any “secret methods” destroy trust and push people away from help.
MythA tough ultimatum will solve the problem right away
FactAn ultimatum without support or a plan more often leads to resistance or hidden drinking and drug use. Clear boundaries work when they are calm, realistic, and paired with an offer of help. It is best to discuss how to set them with a specialist in advance.
Prices: Motivation for treatment
| Motivation for treatment | 25 000 ₸ |
| Residential rehab, per month | 299 000 ₸ |
| Outpatient program, per month | 120 000 ₸ |
| Consultation to choose a program | free |
| Phone consultation | free |
Prices are approximate: the doctor confirms the exact cost after the examination, before treatment starts.
Confidential
We do not register patients with state dispensaries or share information with employers. You do not have to give your surname; doctors arrive in unmarked cars. Medical confidentiality is protected by the Code of Kazakhstan “On Public Health and the Healthcare System”.
Clinic addresses
FAQ
Can we come for a consultation without the patient?
Yes, and this is often the best first step. Relatives describe the situation, and a psychologist or addiction physician helps them understand what is going on, how to talk to the person, and what kind of help to offer. A family consultation can be held online if you don’t have time to drive across the city.
How many sessions does it take for a person to agree to treatment?
Sometimes one conversation is enough; sometimes three to five sessions over several weeks are needed. It is impossible to predict exactly: much depends on the stage of readiness, family relationships, and past treatment experience. We do not promise results the first time, but each session usually moves things forward a little.
What should I say to get the person to agree to a meeting?
Be honest. A calm request works best: “I’m worried about you — let’s just talk to a doctor.” Do not use deception, surprise visits, or accusations. In a family consultation, we help you find the right words and the right moment for the conversation, based on your loved one’s personality and situation.
Will a specialist come to our home?
Yes, an addiction physician or psychotherapist can hold a motivational conversation at home in Almaty and nearby suburbs. The key condition is that the person knows about the visit and is willing to at least listen to the specialist. If the visit comes as a surprise, the conversation usually does not go well, so we discuss the visit with the family in advance.
What should we do if the person is a danger to themselves or others?
If life is at risk — aggression with a weapon, attempts at self-harm, psychosis — call 103 or 112 immediately. This is not a situation for persuasion. Children and young people can get support from the 150 helpline. Once the acute situation is resolved, you can return to motivational work.
Will anyone find out that we contacted you?
No. Consultations at Akalam are anonymous, with no registration at the state dispensary. All information is protected by medical confidentiality under the Kazakhstan Code “On Public Health and the Healthcare System.” If the person agrees to treatment, it will also be anonymous, and it is worth telling them this — fear of exposure often stops people from agreeing.
Sources and review
Prepared by the Akalam medical editorial team based on:
- ICD-10 and ICD-11: mental and behavioural disorders
- Clinical protocols of the Ministry of Health of Kazakhstan
- Code of Kazakhstan “On Public Health and the Healthcare System”
- WHO: mental health and substance use
- NICE and APA clinical guidelines
This information is for reference and does not replace a doctor's consultation. Editorial policy