Background: Identifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, highincome countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low-and middleincome country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients' and physicians' perspectives. Methods: Six primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/ representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention). Discussion: This is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan.

Background: New psychoactive substances are a combined group of chemical substances developed in an attempt to circumvent control and restrictive measures for traditional drugs. Until 2017, the countries of Central Asia remained a gray spot on the maps of epidemiological new psychoactive substances reports. The largest share of new psychoactive substances on the Kazakhstani market became of a serious concern for both the law enforcement authorities and the public health services during the last five years.Objectives: The aim of the study was to assess the proportion of hospitalizations in Kazakhstan related to new psychoactive substances addiction over a three-year period (2016)(2017)(2018) and to describe the patterns of new psychoactive substances use in the sample of admitted patients.Material and methods: This study was a retrospective, cross-sectional investigation using regional databases consisting of the 2018 cases of hospitalizations at 16 state regional mental treatment centers and 3 state narcological clinics across Kazakhstan. We analyzed 345 cases of NPS addiction.Results: The proportion of admitted in 2018 new psychoactive substances patients amounted to 10.01% (9.1%; 11.1%), comprising an ascending trend since 2016. The highest prevalence of the new psychoactive substances addiction was registered in Nur-Sultan, Almaty cities, and North-Kazakhstan region. Cathinones prevailed over other NPS groups (71.9%) and were mostly used in parallel with traditional opioids. Synthetic cannabinoids (28.1%) were associated with herbal cannabis use in three quarters of cases; smoking absolutely prevailed as the main route of their administration. Conclusion:This study suggests that new psychoactive substances addiction is a current clinical phenomenon, which should be reflected in the development and revision of the national drug treatment programs across Kazakhstan. The disparity of new psychoactive substances prevalence in the regions should be considered in the development of local anti-drug plans by the health care service and law enforcement authorities.

Objective: The aim of this pilot trial was to assess the feasibility of ASBI in primary health care units (PHCUs) in Kazakhstan.Methods: A two-arm cluster randomised trial in five PHCUs based on the RE-AIM framework for implementation studies was carried out. Patients with AUDIT-C scores ≥4 for females and ≥5 for males received a brief face-to-face intervention delivered by a trained physician plus information leaflet (intervention group, IG) or simple feedback including a leaflet (control group, CG).Results: Among 7327 patients eligible for alcohol screening according to the inclusion criteria 1148 patients were screened (15.7%, IG: 11.5%, CG: 27.3%). 12.3% (N = 141) were tested AUDIT-C positive (IG: 9.9%, CG: 15.1%). Out of 112 physicians invited, 48 took part in the ASBI training, 31 finally participated in the study, 21 in the IG (2 PHCUs), 10 in the CG (3 PHCUs). The majority of physicians did not have difficulties in performing the intervention.Conclusion: ASBI is feasible and can be implemented into PHC settings in Kazakhstan. However, the implementation depends on the willingness and interest of the PHCU and the physicians.