Reviewed byOlga Smirnova, MDAddiction psychiatrist, experience 27 years · updated 8 Nov 2026
Key facts
- Who provides it
- A psychiatrist and a narcologist jointly, with a psychotherapist on the team
- Where
- Home visit, outpatient or inpatient care — depending on severity
- Duration
- Stabilization 1–3 weeks, ongoing support for 6 months or more
- Anonymity
- No entry on the addiction (narcology) or psychiatric registry
- When it is urgent
- Psychosis, seizures, suicidal thoughts, overdose — call 103 or 112
- Outcome
- Remission from addiction and control of mental health symptoms
What you should know
The term “dual diagnosis” (comorbidity) describes a situation in which a patient has both a disorder related to the use of psychoactive substances and another mental health disorder. These conditions reinforce each other: depression pushes a person toward alcohol as a way to “numb” their misery, while regular drinking deepens depression, anxiety and insomnia. If only one of them is treated, the other often becomes the cause of a relapse or a flare-up.
Dual diagnosis treatment in Yesik at Narcology 24 is based on the principle of integration recommended by the WHO and NICE guidelines: one plan agreed between the psychiatrist, the addiction specialist and the psychotherapist. Detox and stabilization come first, followed by clarification of the psychiatric diagnosis, because many symptoms during intoxication and withdrawal are temporary. After that, long-term treatment for both conditions and a relapse prevention program are put in place.
Signs That Suggest a Dual Diagnosis
- using alcohol or drugs to cope with anxiety or low mood
- depression and insomnia persist for weeks after stopping substance use
- frequent relapses despite “coding,” treatment and a genuine desire to quit
- episodes of suspiciousness, hearing voices or intense fears during or after use
- sharp mood swings, impulsiveness and risk-taking behavior
- suicidal thoughts during a drinking binge or during withdrawal
- a mental health disorder was diagnosed even before the addiction began
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 Often Occur Together
Doctors distinguish between primary and secondary conditions. A primary mental disorder — for example, an anxiety disorder, bipolar disorder or PTSD — may precede the addiction, with the substance being used as “self-medication.” A secondary condition arises because of substance use: alcohol, stimulants and cannabinoids can all cause depression, anxiety and psychotic episodes. Shared risk factors also matter: heredity, childhood trauma, chronic stress and social isolation.
For differential diagnosis, doctors rely on ICD-10: if symptoms persist after a long period of sobriety (usually several weeks), they are regarded as a separate disorder. That is why a final psychiatric diagnosis is often made not on day one but after detox and a period of observation. This is not a delay but a necessary stage, so that no unnecessary treatment is prescribed and no necessary treatment is missed.
How Dual Diagnosis Treatment Works: Step by Step
The stages: 1) an initial consultation — by video with relatives or in person with the patient — to assess the severity of the addiction, mental status and risks; 2) detox at home or in hospital; 3) monitoring during early sobriety and clarification of the diagnosis; 4) selection of long-term treatment: medications to prevent relapse and to treat the mental disorder, taking their compatibility into account; 5) psychotherapy; 6) regular follow-up and work with the family.
Treatment at home is not appropriate in psychosis, alcohol withdrawal delirium (delirium tremens), a history of seizures, suicidal intentions, severe physical illness or use of several substances at once. In these cases inpatient care is needed, and if there is a threat to life, call 103 or 112 immediately. Compulsory treatment is possible only by court decision under the procedure established by the law of the Republic of Kazakhstan.
How we help
Integrated medication treatment
The psychiatrist and the addiction specialist coordinate medications to avoid dangerous interactions. Depending on indications, anti-craving medications, antidepressants, mood stabilizers and antipsychotics are used. Medications with dependence potential, such as benzodiazepines, are prescribed only by a doctor, for a short course and under supervision, because this group of patients has a high risk of misuse.
Detox with psychiatric supervision
Managing withdrawal in a patient with a mental disorder requires special care: anxiety, insomnia and low mood tend to intensify during this period. The doctor monitors the risk of psychosis and suicidal behavior and selects IV drip therapy and symptomatic medications. If there are signs of danger, the patient is transferred to inpatient care.
Psychotherapy for dual diagnosis
Cognitive behavioral therapy, motivational interviewing and training in skills for coping with stress and cravings are used. The psychotherapist helps the patient recognize triggers — such as when low mood leads to substance use — and build alternatives. Work is done individually and in groups; the psychotherapist does not prescribe medication.
Long-term support
The risk of relapse and flare-ups is higher with a dual diagnosis than with a single disorder, so monitoring continues for at least 6–12 months. Visits gradually become less frequent. Relatives receive guidance on how to support sobriety and spot early signs of deterioration. Support is available in person and online.
Myths and facts
MythYou have to quit drinking first and treat the depression later
FactA sequential approach often ends in relapse: without treating the depression, it is hard to stay sober. International guidelines recommend treating both conditions at the same time, within a single plan that takes the detox stage into account.
MythAntidepressants just replace one addiction with another
FactAntidepressants do not cause euphoria or addiction in the clinical sense. Stopping them abruptly can cause discontinuation syndrome, so they are tapered gradually according to the doctor's plan. Certain other drug classes do carry a risk of misuse, and the doctor prescribes them with caution.
MythIf the psychosis went away after stopping drugs, no treatment is needed
FactA substance-induced psychotic episode increases the risk of further episodes and sometimes precedes a chronic disorder. Follow-up with a psychiatrist after such an episode is necessary even if the person feels well.
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 Yesik
| Online psychiatrist consultation | 12 000 ₸ |
| In-person psychiatrist consultation | 14 500 ₸ |
| Psychiatrist home visit | 32 000 ₸ |
| 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 Yesik: 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 — 125 Kamenskaya St., office 38, Yesik and 103 Zhambyla St., Yesik. When indicated, we arrange admission and transport.
Confidential and private
in Yesik 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
Who manages a patient with a dual diagnosis — a psychiatrist or a narcologist?
Both doctors. The narcologist is responsible for detox, relapse prevention and addiction treatment, and the psychiatrist for diagnosing and treating the mental disorder. At Narcology 24, they discuss the plan together, and the patient receives one consistent set of recommendations with no contradictions.
Can a dual diagnosis be treated at home?
Partly, yes: when the condition is stable, detox, selection of treatment and follow-up can be provided on an outpatient basis or through a doctor's home visit in Yesik. In psychosis, delirium, suicidal intentions and severe withdrawal, an inpatient unit with round-the-clock monitoring is safer.
How long does dual diagnosis treatment take?
The acute phase — detox and stabilization — usually takes from a few days to 2–3 weeks. This is followed by a stage of selecting and consolidating treatment, and ongoing support is recommended for at least six months. Exact timelines depend on the substance, the diagnosis and whether relapses occur.
Can I have alcohol “coding” if I have a mental disorder?
Alcohol “coding” (a treatment widely used in Kazakhstan and CIS countries) is decided on only after an examination. In a number of mental health conditions, certain methods are contraindicated or require caution. Any coding is carried out only after the required period of sobriety and with written informed consent, and it is considered part of comprehensive treatment.
How can I persuade a loved one with a dual diagnosis to get treatment?
Start with a consultation for relatives. The doctor will help you choose the right moment and words and explain how to talk about specific problems — sleep, health, relationships — rather than attaching labels. Pressure and ultimatums more often increase resistance than help.
Will I be put on a registry with a dual diagnosis?
With paid anonymous treatment in Yesik, no dispensary registration is made with either the narcologist or the psychiatrist. 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 expressly provided for by law.
Where do doctors visit in Yesik and where are the branches?
Home visits cover all city districts and nearby settlements, 24/7. Appointments at two branches: 125 Kamenskaya St., office 38, Yesik and 103 Zhambyla St., Yesik. Phone in Yesik: +7 (700) 309-30-65.
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
