Reviewed by: Assel Omarova, MD, psychiatrist and addiction specialist · updated 6 Nov 2026
Key facts
- Who provides care
- A psychotherapist, an addiction medicine doctor, an addiction specialist
- Format
- Online family preparation, a conversation with the person online or in person
- Duration
- Preparation takes from a few days to 2–3 weeks
- Anonymity
- Confidential, medical confidentiality under Kazakhstan law
- When it’s urgent
- Overdose, psychosis, delirium, threat of violence or suicide — call 103 or 112
- Outcome
- Voluntary consent to treatment and a ready-made care pathway
What you should know
Refusing treatment is not necessarily a sign that the person doesn’t care. More often it is a mix of fear, shame, denial and ambivalence: the person both wants and doesn’t want to change at the same time. Motivational interviewing, developed specifically for working with this kind of ambivalence, starts from the premise that motivation cannot be imposed — but a person can be helped to find it. Clinical guidelines describe this approach as one of the cornerstones of the early stage of addiction treatment.
An intervention, in the modern sense, is not a sudden confrontation with ultimatums but a carefully prepared meeting at which loved ones calmly talk about their feelings and offer a concrete plan of help. At Psychiatry Online, preparation is done online: relatives can join from different districts — for example, Yesil and Saryarka — without having to meet in person. For families where the adults work in government agencies and offices until evening, after-work video sessions are the only realistic option for regular preparation.
When a Family Should Seek Help With Motivating a Loved One
- your loved one admits the problem but keeps putting treatment off “until later”
- every conversation about the addiction ends in an argument or accusations
- persuasion, threats and tears no longer work, and the situation is getting worse
- the person denies the problem even though the consequences are obvious to everyone around them
- the family cannot agree on how to act and sends mixed signals
- there has been a previous treatment experience, after which the person refuses to seek help again
- you want to hold an intervention but are afraid of making things worse
If heavy drinking has lasted more than two or three days, or there is shaking, vomiting, blood-pressure spikes or insomnia, you need a doctor rather than stopping alone. An online consultation is free and helps assess the risks before a visit. For seizures, confusion or hallucinations call 103 or 112.
Why People With Addiction Refuse Treatment: The Mechanisms
Addiction changes how the prefrontal cortex works — the part of the brain responsible for weighing consequences and planning. That is why denial is partly a neurobiological phenomenon, not just stubbornness. Psychological defenses add to it: admitting the problem means admitting a loss of control, which is painful for self-esteem. The stronger the pressure, the stronger the defense, and the person starts trying to prove they “can quit on their own.”
Refusal is also fueled by practical fears: losing a job, ending up on the state registry, going through severe withdrawal or facing judgment. Many people don’t know that anonymous treatment is possible and that withdrawal symptoms can be eased. Psychoeducation that addresses these fears is part of motivational work. The seasonal factor matters too: during the long winter with short days, mood and readiness for change tend to decline.
How Online Preparation for a Motivational Conversation Works
The first session is with family members only. The specialist learns the history of the addiction, previous treatment attempts, family relationships and risks: violence, suicidal statements, severe binges. The family then learns techniques: how to speak in the first person, how to respond to denial, and which phrases trigger defensiveness. A treatment plan is prepared that can be offered right away. Join with headphones from a room where the person with the addiction cannot hear you — an office, a car or a relative’s apartment.
The conversation with the person themselves can take place online if they agree to join. If the person is intoxicated, in a severe binge or in psychosis, the motivational conversation is postponed; if there is a threat to life, call 103 or 112. Compulsory treatment is possible only in cases expressly provided for by Kazakhstan law and does not replace voluntary motivation.
How we help
Motivational Interviewing
The specialist asks open-ended questions, reflects back what has been said and helps the person hear their own arguments for change. The key idea is not to argue with denial but to explore ambivalence. This approach has been well studied in clinical research and can be used both online and in person, because it is built on dialogue rather than pressure.
The CRAFT Program for Families
An approach that teaches relatives to change their own behavior so that sobriety becomes more rewarding than using: reinforcing sober periods, not cushioning consequences and choosing the right moment to suggest treatment. In studies, it leads people with addiction to seek help more often than confrontational methods and reduces stress within the family itself.
A Prepared Intervention
If gentle methods are not enough, a carefully planned meeting is held. Each participant prepares a short letter about their feelings and specific incidents, without blame. It is decided in advance which treatment will be offered and what the family will do if the person refuses. The specialist rehearses the meeting with the family online and, if needed, takes part in it.
A Ready-Made Treatment Pathway
Motivation fades quickly if weeks of waiting follow the person’s agreement. That is why the first step is already arranged by the time of the conversation: an online consultation with an addiction specialist, a doctor’s home visit, a hospital bed or a place in a rehabilitation program. The shorter the path from “yes” to the first step of treatment, the higher the chance the person will actually take it.
Myths and facts
MythA person has to “hit rock bottom” before they want treatment
FactWaiting for “rock bottom” can cost health and even life. Research shows that motivation is also shaped by a person’s environment. Changes in the family’s behavior and a well-conducted conversation help treatment start sooner.
MythAn intervention means ultimatums and pressure
FactA modern intervention is a prepared, calm meeting where loved ones talk about their feelings and offer help. Harsh confrontation more often strengthens defenses and destroys trust, which is why specialists have moved away from it.
MythIf a relative agreed under pressure, treatment won’t work
FactExternal motivation at the start is perfectly normal. During treatment, it often gives way to internal motivation as the person begins to see the benefits of sobriety. The key is to keep working on motivation at every stage.
How an online appointment works
- Message or callWrite on WhatsApp or call — our coordinator replies within minutes, day or night. You don't have to give your surname.
- Doctor and timeWe match you with a psychiatrist, addiction specialist or psychotherapist and agree on a time — often the same day.
- Video consultationA secure 50–60 minute video call: the doctor takes a detailed history and uses standardised scales if needed.
- Treatment planYou receive a clear summary, recommendations and a plan: what we do online and what needs an in-person visit or home call.
- Follow-upOnline follow-up sessions, messenger contact with your doctor, and treatment adjustments until you get a stable result.
Prices in Astana
| Online addiction specialist consultation | 12 000 ₸ |
| Online consultation for relatives | 12 000 ₸ |
| Addiction specialist home visit | 40 000 ₸ |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
You can book in Astana online or at one of two branches: 72 Bogenbay batyra St., Astana, 37 Petrova St., office 23, Astana. Our coordinator replies on WhatsApp within minutes at any time, and a doctor usually connects by video the same day; home visits are available too — all city districts and nearby settlements.
Confidential and private
An online appointment in Astana is first of all about privacy: no clinic visit, no waiting room. A private room and headphones are enough. Data is stored in a secure system with restricted access and does not enter any state registry without legal grounds.
Questions and answers
Can an intervention be held online?
Family preparation is done almost entirely online. The meeting with the person with the addiction can be in person or by video — this depends on the situation and the person’s consent. Sometimes relatives gather in one apartment while the specialist joins remotely, and this works as well.
How long does preparation take?
From a few days to 2–3 weeks. Usually 2–4 sessions with the family are needed: reviewing the situation, learning techniques, rehearsing the conversation and agreeing on the treatment pathway. In an acute deterioration, such as a prolonged drinking binge, the plan is accelerated and may include a doctor’s home visit.
What should we do if the person refuses?
A refusal after the first conversation is not a failure. The family continues to apply the new strategies, reinforces sober periods and stops taking on the consequences. After a while, the offer is repeated. The specialist helps the family get through this period without falling back into old patterns.
Can a person with addiction be treated without their consent?
Medical care for an adult is provided with their voluntary consent. Involuntary measures are possible only in cases expressly provided for by Kazakhstan law — for example, when there is a threat to life. That is why the main path is motivation, not coercion.
Who should take part in the conversation with the person?
Usually 2–4 significant people whom the person respects and who can speak calmly. It is better not to involve children. If relatives live in different districts or cities — for example, on the right and left banks — they take part in the preparation by video.
Is confidentiality maintained?
Yes. Information obtained during consultations is protected by medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System.” It is not passed on to the employer of the person with the addiction or of their relatives, except in cases provided for by law.
Where can I be seen in Astana?
Online — from anywhere in the city or region. In person — at two branches: 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Both are open 24/7; home visits cover all city districts and nearby settlements.
Sources and methodology
This page was prepared by the Psychiatry Online 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) and APA (US) guidelines on the treatment of mental disorders
- WHO recommendations on telemedicine and digital health
This information is for reference only and does not replace a consultation with a specialist. Editorial policy
