Reforming the Soviet model: Alcohol treatment services in Kazakhstan

Abstract

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of the current alcohol treatment services in Kazakhstan and assesses the extent to which the Soviet model has been superseded.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.

• Alcohol
• treatment
• USSR
• Kazakhstan
• history
• policy

Notes

Notes

1. A field trip undertaken in 2002 was funded by Middlesex University, and three further trips, in May/June 2003 and May and September 2004, were funded by the British Academy as part of a project, ‘Trans-cultural applicability of theories of alcohol consumption and responses to alcohol-related harm’. The British Council assisted in setting up interviews and visits in 2002; our project partners, the Kazakhstan National Centre for Healthy Lifestyles (NCHL) arranged schedules on two subsequent occasions. The authors would like to thank Professor T. Germanyuk, Dr L. Tanasheva and Venera Baisagurova, all of the National Centre for Healthy Lifestyles in Almaty, for their assistance. The Project was considered and agreed by the Ethics Committee of Middlesex University.

2. Interviews Nos 4, 8, 13 and 17, May 2003 and May 2004, foreign aid workers, medical professionals.

3. Interview No 9, medical professional.

4. Interview No 5, May 2003, medical professionals.

5. Interview No 17, May 2004, medical professionals, policy makers.

6. Personal communication, Venera Baisagurova, NCHL, 2005. Interview No 5, May 2003, medical professionals.

7. Interview No 6, May 2003, medical professional.

8. Interview No 9, May 2003, medical professional.

9. Interview No 9, May 2003, medical professional.

10. Interviews No 20, May 2002, medical professionals.

11. Interview Nos 6 and 7, May, 2003, medical professional; legal worker and law enforcement personnel.

12. Interviews Nos 16 and 17, May 2003 and May 2004, medical professionals and policy makers.

13. Interview No 9, May 2003, medical professional.

14. Interview No 5 May 2003, medical professionals.

15. Interview No 7 May 2003, medical professional.

16. Interview no 9, May 2003, medical professional.

17. Interview No 5 May, 2003, medical professionals.

18. Personal communication, NCHL, 2005

19. Interviews Nos 3 and 6 May, 2003, medical professionals.

20. Interview Nos 16 and 17, May 2003 and May 2004, medical professionals and policy makers.

21. Interviews Nos 15 and 16, May 2003, medical professionals, policy makers.

22. Interviews Nos 5, 9, 14, May 2003, medical professionals.

23. Interview No 17, May 2004, medical professionals, policy makers.

24. Interviews No 4 and No 8 May 2003; No 13 June 2003, international aid workers.

25. Interviews No 6 and No 9, May 2003, medical professionals.

26. Interview Nos 3, 5 and 9, May 2003; No 20 September 2002, state employed and private medical professionals.