Dual diagnosis: addiction and mental illness in Astana

Reviewed byOlga Smirnova, MDAddiction psychiatrist, experience 27 years · updated 8 Nov 2026

Key facts

Who conducts it

A psychiatrist and an addiction medicine specialist together; a psychotherapist works with the patient and the family

Where

Home visits, inpatient care, outpatient and online follow-up

Duration

Detox takes days, selecting therapy takes weeks, and ongoing support lasts months

Anonymity

Paid anonymous treatment with no registration at the state dispensary

When it's urgent

Delirium, seizures, psychosis, suicidal thoughts, or an overdose — call 103 or 112

Outcome

A stable mental state and a lower risk of relapse when the plan is followed

What you should know

Relatives of people with a dual diagnosis often go around in circles for years. The addiction specialist says, “Stop drinking first, then see a psychiatrist.” The psychiatrist replies, “As long as he's drinking, there's no point treating the depression.” Meanwhile, at home, a husband relapses again after three sober weeks because he can't bear the anxiety, or a son who smoked synthetic blends for years starts hearing voices. The family can see that there are two problems and that they are intertwined, but doesn't know which one to tackle first.

At Narcology 24, these two lines of care are not separated: the psychiatrist and the addiction specialist discuss the patient together and draw up a shared plan. For the family, this means one coordinator instead of going from office to office. In Astana, this approach is especially in demand: many people have moved from other regions, work long overtime hours, and “hold on” for a long time with alcohol or sedatives until their condition becomes dangerous. The sooner relatives seek help, the better the chance of avoiding serious complications.

Signs of Dual Diagnosis That Families Notice

• the person drinks or uses drugs to “drown out” anxiety, sadness, or insomnia
• during sober periods they are depressed, irritable, can't fall asleep, and relapse again
• after using, they become suspicious, fearful, hear voices, or express strange ideas
• mood swings persist even after several weeks of sobriety
• they take sedatives or sleeping pills on their own without a doctor's prescription
• they talk about death, especially when intoxicated or hungover
• treating only the addiction or only the depression has not worked in the past

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 Addiction and Mental Disorders Make Each Other Worse

Alcohol and other substances temporarily relieve anxiety and tension, so a person with depression or an anxiety disorder can easily start “treating” themselves with them. But relief is followed by a downturn: sleep becomes shallow, mood drops, and anxiety grows. To cope, they need another dose. This creates a vicious circle in which addiction and the mental disorder sustain and mask each other.

The sequence can also be reversed: long-term substance use itself causes mental disturbances — depression, anxiety, psychosis. A primary disorder can be distinguished from a substance-induced one only after a period of sobriety and observation by a doctor. That is why it is important for relatives not to diagnose the person themselves and not to wait “until he quits.” According to international guidelines, treating both conditions at the same time gives better results.

How we help

Myths and facts

How a home visit works

1. 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.
2. 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.
3. 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.
4. 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.
5. Further treatmentCoding, psychotherapy, rehab or psychiatric follow-up — once the acute state has passed and the person is ready.

Prices in Astana

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