Reviewed byNurlan Isayev, MDAddiction psychiatrist, experience 10 years · updated 8 Nov 2026
Key facts
- Who provides care
- A psychotherapist and an addiction counselor, plus an addiction doctor for medical support
- Where
- Sessions at the clinic in Astana and online, consultations for relatives
- Duration
- Active phase: 3–6 months; maintenance sessions: up to 12 months or longer
- Confidentiality
- Medical confidentiality, no registry, no data shared with third parties
- When it’s urgent
- A heavy binge, overdose, psychosis, suicidal thoughts — call 103 or 112
- Outcome
- A personal plan, recognition of early signs, a prepared family, and fast help in case of relapse
What you should know
Relatives often live in fear: “What if it happens again?” After treatment, every late return from work, every bout of irritability or bad night’s sleep seems like a sign of trouble. It is important to know that a relapse doesn’t start with the first sip or the first bet. It is preceded by weeks of changes in mood, thinking, and behavior, and these are exactly what can be noticed and stopped. Relapse prevention is a skill that both the person and their family learn, step by step.
Astana has its own risks: the long winter with less daylight and activity, corporate parties and holidays, rotational shift work, and life far from family for those who have moved from other regions. We take all of this into account in the plan. The family receives clear instructions: which signs to discuss calmly, when to call the specialist, and when to call 103. Follow-up is available in person on both the left and right banks and online, including in the evening after work.
Early signs of relapse that families notice
- growing irritability and touchiness; the person has become curt for no obvious reason
- skips sessions, groups, or medication, saying “I don’t need this anymore”
- disturbed sleep, fatigue, no longer taking care of themselves or eating properly
- reminisces about the “good times” with alcohol or drugs, romanticizes the past
- has reconnected with the old crowd, looks for excuses to celebrate
- hides spending, time, and their phone; small lies start appearing
- says “just once won’t hurt” or “I’ve got it all under control now”
If two or three points apply, it is worth seeing a doctor. Phone advice is free and confidential. If life is at risk, call 103 or 112.
Why relapses happen and how the process works
Addiction is a chronic disease, and changes in the brain persist long after substance use stops. Specialists describe stages of relapse: emotional (stress, built-up resentment, poor sleep), mental (an inner tug-of-war, memories, plans for “just once”), and physical — the actual use. Prevention is most effective during the first two stages, when the person can still stop and seek help.
Triggers are situations, people, places, emotions, and even seasons associated with past use. Common causes of relapse include stress at work, family conflicts, loneliness, fatigue, holidays, and having cash on hand. Untreated depression and anxiety increase the risk. Understanding your own triggers and having a ready-made plan of action significantly lower the likelihood of returning to use.
How the relapse prevention program is built
The psychotherapist and the person draw up a personal plan together: a list of triggers, early warning signs, and specific actions for each stage — whom to call, where to go, what to do instead of using. Then come regular sessions, weekly at first and less often later, in person in Astana or online. If needed, the addiction doctor adds medication support. The family attends separate consultations and gets their own version of the plan: what we notice, what we say, whom we call.
If a relapse has already happened and the person is on a binge or under the influence of substances, prevention turns into treatment: a home visit from an addiction doctor or inpatient detox may be needed. If there are signs of overdose, psychosis, seizures, vomiting blood, or suicidal thoughts, call 103 or 112. Online follow-up works well during periods of stability but does not replace emergency care.
How we help
Personal prevention plan
A written document the person draws up together with the specialist: their triggers, signs of deterioration, ways of coping with cravings, support contacts, and actions to take in case of relapse. The plan is reviewed regularly. With the patient’s consent, loved ones receive a copy so that everyone knows how to act at a difficult moment without panic or blame.
Cognitive behavioral skills
The person learns to recognize automatic thoughts (“just once won’t hurt,” “I’ve earned it”), to cope with cravings using distraction and “urge surfing” techniques, and to solve problems without turning to the substance. These skills are the foundation of relapse prevention in international guidelines. They are practiced in sessions and in real life between them.
Medication support
When indicated, the addiction doctor may prescribe medications that reduce cravings or help maintain sobriety, and may also treat depression, anxiety, and insomnia. Alcohol “coding” (a treatment widely used in Kazakhstan and CIS countries) and blockade treatments are used only after an examination, the required period of sobriety, and written informed consent, as part of a comprehensive plan, with no promises of “forever.”
Family education
Relatives learn what the early signs of relapse look like, how to talk about them without blaming, how to support the routine and the sessions, and how to respond if a relapse does happen. We teach the difference between care and control. A family that knows the plan feels less anxious and becomes a real source of support rather than additional pressure.
Myths and facts
MythA relapse means all the treatment was in vain
FactRelapse is a common part of the journey with a chronic illness, not a failure. The skills and experience remain. What matters is to quickly return to the specialist and use what happened as a lesson for adjusting the plan.
MythIf the person has been sober for six months, the danger is over
FactThe risk decreases over time but does not disappear. Stress, loss, or holidays can trigger cravings even years later. Maintenance sessions and groups help people stay vigilant without living in constant fear.
MythThe family should keep quiet about warning signs
FactOn the contrary, a calm conversation about the changes you’ve noticed helps. The key is to talk about facts and your own feelings rather than to blame. An early conversation can stop a relapse at the emotional stage.
How a home visit works
- Call or message usThe dispatcher answers 24/7 and in 3–5 minutes checks the person's condition, age, how long the drinking or use has lasted, chronic conditions and the address. No surname needed.
- The doctor sets offAn addiction doctor or psychiatrist comes with equipment and medication. Travel time depends on the district — usually within an hour. If inpatient care or an ambulance is needed, we'll say so straight away.
- Examination and treatmentBlood pressure, pulse, oxygen saturation, blood sugar if needed and a neurological check. Then an IV drip or other treatment as indicated, 1–3 hours.
- A plan for the next daysAdvice for the family on what to do overnight and tomorrow, phone follow-up and a repeat visit if needed.
- Further treatmentCoding, psychotherapy, rehab or psychiatric follow-up — once the acute state has passed and the person is ready.
Prices in Astana
| Rehab programme consultation | 12 000 ₸ |
| Outpatient programme (one month) | 150 000 ₸ |
| Residential rehab (one month) | 400 000 ₸ |
| Phone advice | free |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
Narcology 24 in Astana: our duty team makes home visits day and night, usually within an hour (all city districts and nearby settlements). Two branches for appointments and procedures — 6 Auezova St., office 37, Astana and 176 Imanova St., Astana. When indicated, we arrange admission and transport.
Confidential and private
in Astana our doctor can come in ordinary clothes in an unmarked car. Treatment documents are given only to the patient. If you need a certificate or sick note, this is discussed separately and only at your request.
Questions and answers
How do I talk to my loved one if I see signs of relapse?
Choose a calm moment and be specific: “I’ve noticed you’ve stopped going to group and aren’t sleeping well, and I’m worried.” Don’t blame or threaten. Suggest getting in touch with the specialist. If you agreed on a plan in advance, refer to it — that makes the conversation easier.
What should I do if a relapse has already happened?
Stay calm and don’t make a scene while the person is intoxicated. Ensure safety, and if there is a threat to life, call 103 or 112. Once the person is sober, discuss getting back into treatment. The specialists at Narcology 24 can help: a home visit from an addiction doctor, detox, and an updated relapse prevention plan.
How do we get through holidays and corporate parties?
Think through a plan in advance: whom to go with, what to drink, when to leave, and whom to call if a craving hits. It is fine to skip risky events in the first months. Relatives may want to agree on alcohol-free celebrations at home. Discuss difficult dates with the psychotherapist ahead of time.
The person had a drink and went outside in winter. What should I do?
In Astana’s frost and wind, an intoxicated person can quickly become hypothermic, even if they seem fine. Call them and their acquaintances; if they don’t answer or may be outdoors, call 112 or 102. If you find them, get them somewhere warm, and if they are in poor condition, call 103.
Is follow-up needed if the person feels well?
Yes, especially in the first year. Feeling well is the result of treatment, not a reason to stop it. Maintenance sessions every 2–4 weeks, in person or online, help catch changes early. The frequency is decided together with the specialist.
Does treatment information remain confidential?
Yes. Narcology 24 works on an anonymous, paid basis, without registration on any registry. All information is protected by medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System” and is disclosed only in cases provided for by law. Loved ones receive information only with the patient’s consent.
Where do doctors visit in Astana and where are the branches?
Home visits cover all city districts and nearby settlements, 24/7. Appointments at two branches: 6 Auezova St., office 37, Astana and 176 Imanova St., Astana. Phone in Astana: +7 (700) 309-30-17.
Sources and methodology
This page was prepared by the Narcology 24 medical editorial team based on:
- International Classification of Diseases ICD-10 and ICD-11, World Health Organization
- Clinical diagnosis and treatment protocols of the Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- NICE (UK) guidelines on alcohol and drug misuse and mental health conditions
- WHO recommendations on the treatment of substance use disorders
This information is for reference only and does not replace a consultation with a specialist. Editorial policy
