Reforming the Soviet model: alcohol treatment services in Kazakhstan

Based on documentary and interview material this article reviews key aspects of the current alcohol treatment services in Kazakhstan and assesses the extent to which the Soviet model has been superseded. Before 1991, alcohol services in Kazakhstan were typical for the USSR: government providers delivered psychiatry-led treatments free of charge as part of a centralised and hierarchical system in which compulsion and breaches of confidentiality were integral. Since independence, the collapse of the communist state and the introduction of a market economy have altered the context in which the Soviet model of treatment services operates. There is no longer a single centralised provider and treatment is no longer necessarily free at the point of delivery. However, within the statutory sector, which still dominates service provision, the individual components of the Soviet model are relatively unchanged. Reforms in methods and delivery of treatments are likely to take place as economic prosperity increases and professional isolation weakens; the extension of patient rights may depend on wider social and political developments in the republic.