As clinicians, three key qualities are essential. First, a deep understanding of the neuroscience behind behaviours that can become problematic. Secondly, knowledge of appropriate treatment methods. And thirdly (possibly the most important), the ability to truly hear an individual's story. A skill that looks beyond the spoken word to see the essence of someone, to notice what is not spoken and to understand the significance of both.

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Speaking to Fiona Faulkner, our Partnerships and Community Lead and one of our Clean Slate nurses, you immediately get a sense that she embodies all of these qualities.

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On paper, Fiona has all the attributes of a well-studied professional, who has made learning her mission, formally studying nursing, mental health nursing and a Masters in Social Work, informally studying various interests from sign language, pottery to yoga teacher training.

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Speaking with Fiona, she reflects on her journey into healthcare;“I have always had a sense of social justice, I was always drawn to people who needed help or support.  As a teenager I wanted to study social work and that was realised when as a mature age student I chose nursing which was the prerequisite into the Master program, hence taking that route. I feel so lucky to work in a way that combines both my passion, my skill set and in a role that I am able to give back"

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Fiona's nursing career commenced in a forensic mental health unit in Tasmania, and it was here that she witnessed first-hand the ability of the mind to adapt and make change.  

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"I remember thinking, if people can make sense of these situations, when it would seem all is lost, then why do we who seemingly have everything feel we can not cope with our struggles. Working in that unit gave me the gift of perspective and cemented the notion of enduring hope."

It was while working in this unit that Fiona completed her postgraduate nursing qualifications in Mental Health and Master of Social Work. Fiona recalls a lecturer who worked for the Alcohol and Drug (AOD) unit who invited her to apply for a position within the AOD team. She was successful and recounts;"As soon as I switched to AOD, I knew I was home. I owe my career in this field to that lecturer, who then became my boss. I love working with people to see that change is possible. One of the most rewarding aspects of this work is when clients share that they feel like themselves again, that they're finally able to remember themselves and start moving towards their goals. It's incredibly motivating to witness these transformations and I feel so lucky that I get to hear these stories from Clean Slate Clients on a daily basis".

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Fiona was one of the first nurses to join Clean Slate. What she immediately loved about the approach was the long term support she could provide to clients throughout their recovery journey.

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"I love that clients get continuity of care with Clean Slate. In traditional alcohol and drug services, clients are often handed from one team to another for assessment, detox, and rehab. This system can be difficult to navigate, a barrier to accessing treatment, especially when people are at their most vulnerable.

"With Clean Slate, I can see a client from the very beginning, hear their story, connect with them and assure them that I’m going to be working with them for the next twelve months, and I'll be there to remind them of how far they've come and will celebrate the changes they've made, the insights they have gained. This makes a real difference in their recovery journey."

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Fiona's genuine warmth and empathy shines through the screen via telehealth or zoomlines. It's not all virtual though - Fiona takes regular trips out to Western QLD to work alongside the wonderful Armajun Aboriginal Health Team and recently took a trip out to Mt Isa with the Western Queensland Primary Health network team to identify additional ways Clean Slate Clinic can make their services accessible for all Australians regardless of geographical constraints.  

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Whilst out West Fiona was able to catch up with some of her patients face-to-face.  

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"When you are working with people for twelve months, you become part of the furniture, these people I work with are an inspiration to me and it is lovely to meet them face to face when I can."

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Fiona is a big fan of the telehealth approach. She says that some Clean Slate clients would struggle to get treatment otherwise because of where they live or what's going on in their lives. Many people can not leave pets, family, jobs or property to travel to a detox facility, so being able to do this work with people, in their homes, makes all the difference.  

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"When you're talking to new clients, it's often a relief for them. They'll say, 'Oh, I didn't even know this was an option.' For people in regional areas, the receptionist at the local medical centre might be a mum from the tuck-shop roster, or the doctor might play soccer in your team. People don’t want to have these conversations in spaces they feel they may be judged. Clean Slate Clinic provides a safe option for these people.

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"Being able to form an alliance with somebody online who can offer support while keeping things confidential is really great. I've got clients who don't get mail regularly, might not have reliable internet, or don't get to town often. For these people, or for those who can't leave home for whatever reason, this service is invaluable."

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Fiona's long career working in various health environments means she is no stranger to unhelpful emotions and problematic behaviour or substance dependence. She believes for some people it is helpful to experiment with different strategies to cope with these issues and client feedback indicates she excels at providing a judgment-free environment for people to share their stories and do the work.

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"I always ask clients what benefits they've experienced from abstinence," Fiona shares.

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"The responses never get old. Clients report increased mental clarity, waking up energised, reduced anxiety, better sleep, and even significant weight loss. One client told me they feel like a kid on Christmas morning when they wake up now. Another said they can finally take road trips again, they are no longer anxious about being on a highway. Alcohol and other substance use can keep you from enjoying certain aspects of life and it’s incredibly rewarding to hear these milestones along people’s journey."

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While all stories are different, the common thread is the resilience that clients develop.

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"Developing the ability to cope with cravings has a broader impact. If you can sit through that discomfort, it strengthens your ability to cope in other situations. Change doesn't happen in isolation. One change creates a ripple effect, impacting various areas of life. I really enjoy exploring this process with clients, unpacking how their growth in one area positively influences others."

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When asked about the potential for cultural change in Australia regarding alcohol consumption, Fiona is optimistic. Despite the deeply ingrained drinking culture, she sees positive signs through her interactions with patients and the growing awareness of programs like Clean Slate. The rise in popularity of zero-alcohol drinks also indicates a shift in societal attitudes towards alcohol consumption.

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Fiona's career path, starting later in life after raising a family, has given her a wealth of life experience that complements her extensive studies. Her knowledge of AOD is impressive, but it's her ability to connect with individuals and offer hope that truly sets her apart.

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Fiona's words of wisdom resonate deeply: "Trust the process, take it one moment at a time, and believe that change is possible."

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This simple yet profound advice encapsulates her approach to recovery, offering hope and encouragement to those on their journey to sobriety. It's a testament to Fiona's compassionate nature and her unwavering belief in the potential for transformation that lies within each of her clients.

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What Fiona is Reading:

• Robert Greene ‘The Laws of Human Nature’
• David Treleaven ‘Trauma Sensitive Mindfulness’

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Fiona's Favourite Guided Meditation:

• Goodful ‘Ten minute meditation for anxiety’

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Fiona's Suggested Bedtime Routine:

• Ally Boothyoyd, Sarovara Yoga ‘Yoga Nidra Healing Meditation’
• Rain Sounds overnight

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Where's Home?

"Mostly Hobart, but I am always getting on a plane, I love to travel and visit family."

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Fiona's Pets?

Sadie and Hazel… poodle cross queens.

But her favourites really are the chickens… Bonnie, Clyde, Melissa, Simone and Lucky.

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Answer me this  

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Mountains or Sea?

"I need to be able to get in the ocean, but I am planning to hike Lake Rhona this summer… so maybe both."

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Best thing today?

"My chickens, hands down the best thing every day! But today the neighbour's sheep came up onto my veranda to say hello, that was pretty cool."

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Your Superpower?

"My imagination and once I decide to do something, I do it… I might be slow, it might take a long time but if I say I will, I will."

Happy festive season from Clean Slate Clinic!

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Clean Slate Nurse Maz (Marion Jarvis) is serving up quite a treat of recipes for all our lovely clients who want to raise their spirits without raising a glass. They look great and taste even better. Thanks Maz!

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And see below for a list of her tasty non-alcoholic bevs you can start to test out.

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Non Alcoholic Christmas Punch

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Ingredients:

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• 2 cups low sugar Cranberry juice
• 1 cup Orange juice
• 1 cup Pineapple juice
• 2 cups Sparkling Apple juice or cider *see notes for low sugar option
• 1 cup Ginger Ale
• Orange slices, cranberries, pomegranate seeds and/or cherries for garnish

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Instructions

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1. Mix cranberry, orange and pineapple juice in a punch bowl or large jug.
2. Add sparkling apple juice/cider and ginger ale and mix gently.
3. When you're ready to serve, add ice and fruit of your choice to garnish.

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Other Popular Mocktails from ‘The Mindful Mocktail’

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• Sunrise Mocktail
• Piña Colada Mocktail Recipe With Only 3 Ingredients
• Virgin Cosmopolitan Mocktail
• The Best Virgin Strawberry Daiquiri
• Ginger Mojito Mocktail Nonalcoholic
• Watermelon Agua Fresca

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Maz has also suggested experimenting with some of the ingredients below:

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• Cranberry juice - I like using low sugar juice but this really is personal preference.

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• Orange juice - Freshly squeezed juice works well and adds to the nutritional content of the punch. If you're making a larger batch, bottled juice will be more economical.

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• Pineapple juice - choose any brand you wish! Golden Circle is always a nostalgic Australian hit.

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• Sparkling Apple cider or juice - Again this is a personal preference. I use a sparkling Apple juice called Appletiser and it's divine.

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• Ginger Ale - The ginger adds a lovely kick and some extra bubbles to the punch. I'm a huge fan of bubbles! I always use low or reduced sugar. Club soda is a great replacement if you don't have Ginger Ale or are looking for a low-sugar alternative.

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• Fresh fruit - The sky is the limit! I personally love cherries, pomegranate seeds and orange slices. Cranberries also work well and add a little festivity. I found some frozen cherries which worked two-fold - they looked delicious and acted as little ice blocks to keep the drink cool.

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• Ice - I find larger ice cubes work really well and keep the punch nice and cold. If you don't have a large ice cube tray, regular-size ice is fine too.

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• Club soda - Traditional club soda gives the punch recipe a lovely fizz without the additional calories. It's a win-win!

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• Pomegranate juice - I do a non-alcoholic mulled wine and am a huge fan of organic pomegranate juice. The deep red colour also adds gorgeous festivity to this holiday drink.

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• Lemonade - A super obvious way to sweeten the punch. I try to avoid lots of sugar, but there are some fantastic sugar free lemonades out there now.

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• Apple juice - If you're not a fan of the sparkling version, regular apple juice works well too. I always suggest organic where possible.

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• Alcohol-free sparkling wine - Another perfect way to add bubbles to your punch! The wine also adds a lovely 'adult' feel to this recipe.

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• Alcohol-free red wine - A sparkling or still non-alcoholic red can add a beautiful flavour and colour to your punch. Get creative!

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Tips:

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If you make this in advance leave the sparkling ingredients out and add at the last minute so you don't lose any of that lovely fizz. Leave the ice out until you are almost ready to serve so it doesn't melt and dilute your delicious punch.

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Merry Christmas, Happy Holidays, and enjoy!

Nurse Maz

Dr Chris Davis - GP, AOD Specialist, and Co-Founder of Clean Slate Clinic – reflects on the power of celebrities sharing their experiences with substance use to educate others about the pervasive ubiquity of dependence in our society.

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As a doctor specialising in addiction treatment, I've witnessed countless cases of people seeking support for alcohol and substance use across the UK and Australia. But Jackie O Henderson’s recent journey caught my attention because of the important lessons we can learn about recovery from those in influential positions.

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I started work as a GP in London and emigrated to Sydney in 2014. When the covid pandemic hit, I realised two things. One – that there was a dramatic increase in the use of alcohol over lockdowns. Loneliness and boredom played out, there were increased environmental pressures, and it was generally just a dizzying time when it was difficult for people to find balance. For many, their relationship with alcohol or other substances became challenging - and those were the people coming to me to seek treatment at that time.

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Two - just as the need increased, inpatient treatment facilities and face-to-face GP services were dramatically scaled back because of covid, creating huge gaps in access. I recognised that these two issues needed addressing and initiated a telehealth program to assist patients with at-home treatment, including medical withdrawal. The approach combined online support from clinicians with personalised treatment programs, including medication for withdrawal, and online group support, tailored to each patient's specific needs.

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The program proved remarkably effective, with significantly lower relapse rates from patients who might have tried other treatment methods, and patients feeling safe from stigma by having the confidentiality of a home-based program. When covid restrictions eased and most things went back to normal, I really saw the power in what had happened over this time - we had opened up another option for treatment, accessible no matter where you lived in Australia. We wanted to continue on this trajectory in a focused and deliberate way - because I could see first-hand the positive results at-home treatment was having on patients.

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Reflecting on Jackie O’s Story

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Seeing Jackie's story recently - along with other media personalities like Ash Grunwald, Tom Holland and Elle McPherson sharing similar experiences - has resonated with me more than just 'celebrity news'. It's highlighted that unhealthy relationships with substances affect many people across society, and these experiences are far from uncommon.

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In light of Jackie’s story, I wanted to share some important aspects of addiction and recovery that I've observed:

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Stigma:

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Celebrities do have a certain power to remove the stigma and shame associated with alcohol or other drug dependence. High-profile people in the media are regular human beings, but to many, they are icons and role models, and they can impact the general public in meaningful ways. They have the platform to tell a vulnerable and transparent story that can have a greater impact on broader audiences.

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Jackie's openness about her journey is invaluable and has the power to break down the stigma of substance dependence and encourage others to seek help.

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Jackie O Henderson's Instagram post acknowleding that the profits of her book will be donated to Odyssey House Drug and Alcohol Rehabilitation Centre.

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Addressing stigma is a major step towards changing societal views on alcohol and other drug dependence. As healthcare professionals, I believe we need to normalise conversations about substance use, addressing these issues early and creating an environment where patients feel encouraged to ask questions and seek support.

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Early Intervention:

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Early intervention is something that we try to encourage as GPs when addressing substance dependence. In Jackie's case, a friend had intervened and suggested she seek support. Close friends and family often recognise the impact of stress and alcohol consumption on their loved one’s well-being and it’s great to be able to have candid discussions like this. Recognising that there is a problem early on, can significantly improve outcomes.

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Alarmingly, we know it takes on average 18 years for individuals to seek help for alcohol issues, which is a pretty hefty statistic. In my practice, I try to create an environment where people feel comfortable seeking help at the earliest signs of concern. I encourage patients to be aware of changes in their drinking patterns, especially in response to stress or life changes.

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Many people use alcohol or other drugs as a means to stave off feelings of pain. They can serve as coping mechanisms to bury trauma, or in the case of Jackie O - high stress and possibly burnout from a demanding public career. Whatever these original pain points are - in the moment we rarely stop to look at what the cause might be. What I tell my patients is that if you have repetitive behaviours in your life that aren’t healthy - you might think it’s just ‘you’. You may have accepted it as a part of your identity. But an unhealthy relationship with alcohol or other substances can be addressed with the right support, including safe withdrawal if you have become physically dependent, and finding better coping mechanisms that enable you to live a life where you are thriving, not just surviving.

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Financial Barriers:

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Jackie was in a more privileged position, where going to an inpatient facility overseas was an option for her. It gave her the comfort to withdraw, but also the ability to remain discreet during the process.

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Unfortunately, this isn’t an option for so many other Australians. CEO of the Victorian Alcohol and Drug Association, Chris Christoforou was recently sharing a study that showed a 93% increase in wait times for clients seeking treatment since the first survey was undertaken in 2020. And this is just in Victoria.

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The Clean Slate home-based model we’ve created, is another way to offer greater anonymity and confidentiality, which also allows people to stay in the context of their existing lives and withdraw around comfortable surroundings – whether that be staying with their pets, support people, or just being able to continue with their other daily routines.

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According to KPMG’s independent report for Rethink Addiction, there is a shortfall in treatment placements in Australia of about 500,000. We’ve been working with private health insurers to enable access to free placements in the Clean Slate program, as well as created a model that is about 25% of the cost of traditional private programs. We also have government-funded placements in Western QLD, Western NSW and Central & Eastern Sydney, for individuals who are struggling with affordability.

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We really need to shift the needle and address how we can help more financially vulnerable people - this is something we are actively campaigning for the Government to address.

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Key Takeaways:

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Jackie’s journey reminds us that behind every case of substance dependence is a human deserving of compassion and support. To me, her tender honesty, as well as other celebrities who have come forward, will likely allow people who are similarly struggling to reach out - even if they have been living in a state of heightened anxiety.

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We’re doing what we can to make effective services available to more people. Further government support would be a great start, and whilst there is still much to do in this area, we are making progress and moving towards growth and cultural change, and I’m optimistic about the future.

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I’m also thankful to all those in the public sphere who come forward bravely and acknowledge their own stories. Their courage not only helps destigmatise substance dependence but it can set others on a path of positive change too.

Clean Slate is pleased to announce its new partnership with leading insurance provider, nib.

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This partnership represents a significant step towards ensuring quality addiction recovery services are accessible to Australians, regardless of their location or circumstances by being delivered entirely via Telehealth.

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Under this partnership, eligible nib members can be granted funded placements in Clean Slate’s 12 month at-home alcohol detox and recovery program. This initiative aims to bridge the gap in access to quality care, particularly for those in regional communities who often face barriers to essential support services.

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Pia Clinton-Tarestad, CEO of Clean Slate, says more than a million Australians suffer from alcohol dependence and partnering with nib will significantly enhance access to recovery services for people struggling with alcohol dependence.

"We are incredibly excited to join forces with nib to benefit their members. Through nib’s extensive reach, and with Clean Slate's expertise and leading outcomes in alcohol management, we're making an important step towards addressing a critical health issue that affects millions of Australians.

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“We're grateful for nib’s vision and passion for improving health outcomes for its members, and look forward to delivering high-quality, accessible and judgement-free care to people who need our support, as we continue to strengthen and expand our services across the nation."

Nib has grown to become a trusted name in health and medical insurance, providing cover to more than 1.5 million Australian and New Zealand residents, as well as more than 180,000 international students and workers in Australia.

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Ed Close, Chief Executive of Australian Residents Health Insurance at nib, says the partnership with Clean Slate will deliver more support to eligible nib members.

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“Through our Healthcare At Home program we’re able to provide a suite of options for Australians to receive care from the comfort of their homes. With such a large number of Australians managing alcohol dependence, we’re pleased to partner with Clean Slate to deliver quality addiction recovery services”.

To find out more about the program, visit https://www.nib.com.au/health-management-programs/health-care-at-home

Journalist, photographer and filmmaker, Tom de Souza (@storiesfromthescenicroute) reflects on his recovery from ice and gives an honest voice for Men's Health Month.

*Please note that this content discusses substances other than alcohol and comes with a trigger warning.

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I injected ice for the first time at age fourteen. I came from a good home and a good family. The eldest of four kids, we spent the first eight years of my life in an affluent area of London, where I also attended a private school.

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Our family began to fall apart when my dad lost his high-paying finance job in late 2002. It set in motion the great catastrophe of migration. My Australian parents decided now was time to return home, and back in Perth, Western Australia, Dad struggled to find work and Mum became the breadwinner. Money problems mounted, eroding the harmony and stability of our family unit.

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Meanwhile, I struggled to find my feet in a new school, a new culture, a new world. I moved schools three times, eventually winning an academic scholarship to an elite private boy’s senior school. The scholarship helped to solve some of our parent’s financial problems, but I crumbled under the pressure of expectation and the school’s ruthless culture of conformity.

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Uncomfortable in my own skin, I was determined to destroy myself.

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You may be reading this and thinking, yeah, right. Spoiled, rich white kid rebels because he lost all the privilege he had grown entitled to. But the issues that afflicted me were the same that afflict all of us across Australia. Most men end up in prison or addicted to drugs because they are ill-equipped to deal with those issues.

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I, like all young men, had to struggle to learn to love and accept who I was. To find a place in the world and discover joy and purpose and meaning in my life. To deal with pain and hardship in an insightful and constructive way.  And as my family fell apart, I lacked the guidance and insight to find my way through these things, and slipped through the cracks.  

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Ironically, it was when I first became involved with the youth justice system that I discovered drugs. In 2008, I was busted by the police with a huge stash of white powder. It was only caffeine pills that my mum had found hidden in my bedroom, but when she asked me what they were I said nothing. I was angry and did not have the self-awareness to communicate how I felt. I punished the people around me to try to show them those feelings.

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In reality, punished myself.

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The police convinced my parents that a night in the cells of a juvenile remand centre would shock me into change. Despairing of options, they broken-heartedly agreed. In fact, juvenile detention had the complete opposite effect. It instilled in me a hatred of authority, told me that society rejected me, and forced me to adapt to a criminal world.

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I found myself in the revolving door of the criminal justice system. I returned to juvie three times in the next three months, before I was bailed into a youth drug rehab. Here, I lived with a group of older boys and girls, most of them experienced drug users. They taught me more about ice and criminal behaviour than I ever could have learned otherwise. Drugs and crime were glamorised and I became enamoured with them. I went looking for them soon after getting out of drug rehab.

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Not long after, my parents divorced.

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My behaviour was both a symptom and a cause of the family breakdown but in my adolescence, I was at the centre of my own universe and I assumed responsibility. All at once I felt the guilt and anger and pain of my entire world being ripped apart, the sadistic pleasure of greater freedoms, and a longing for respite from the chaos the divorce might bring.

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I understood none of these feelings at the time, and I sought to block out all of the feelings the only way I knew how.

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Ice.

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I found it through a veteran junkie named Mado. At 35-years-old, he was over 20 years my senior. Mado groomed me to inject drugs and schooled in me in ways to fund a prescient habit: drug dealing, stealing.

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I looked up to Mado. He was the only kind of male role model I was permeable to. I was riddled with anger towards my father, and Mado curated a false sense of belonging and guidance. I was vulnerable to his influence. Especially while high on ice.

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My descent into total addiction was rapid and all consuming. A few months after my first shot, I had a $400 per day habit. Ice vanished any sense of empathy and compassion in me, and I did anything I could to fund my habit. I stole from people I loved, I hurt people who tried to help me. I didn’t care for their pain or their hurt. All I cared about was that moment, that second, and what I could get into my lungs or up my arm.

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All drug users arrive at a point where their drug use is no longer fun; it is a matter of compulsion and habit. Mine came as a rapid succession of catastrophic events, which also helped me to realise the need for change.  The first was a psychotic episode: after ten days awake on ice, I flipped out and went chasing a non-existent figure about the streets with a meat cleaver.  Fortunately, I was arrested before I could realise any harm. The second was a failed suicide attempt. The last, a murder committed by two of my closest friends.

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Shortly after they were arrested and charged with murder, I was in the courtyard at school, awaiting an upcoming careers counselling session. It was a literal fork-in-the-road moment.  The outcomes of each lay clearly ahead of me. Down one road was a life-sentence in prison. Down the other, the possibility of a future: an apprenticeship in cooking, or a career as a teacher, journalist, or writer. A multitude of choices and freedom.

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Perhaps the most difficult part of giving up drugs is relearning how to live. Remaining sober is a question of willpower but starting all over again is a lonely and disconcerting business. You need new everything: new friends, new habits, new hobbies. For years, I found negotiating an overgrown, winding path between the two worlds: unwilling to turn back to the world of drugs but institutionalised and isolated from regular society.

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After such an intoxicating emotional rollercoaster, it is also difficult to find joy in the simple pleasures of life. Studies show it can take the brain almost two years to recover and begin producing normal levels of dopamine after prolonged methamphetamine use. Surfing helped me immensely with this. It made me feel good and clean, and gave me a natural healthy substitute to ice.

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I discovered a sense of purpose with some help from my grandfather, Ian, a renowned artist. I sought his counsel as I struggled to find my way. We cooked and played music together, and I saw the passion he derived from his art. For him, art was a way of life. He applied a creative way of thinking in everything in his life, from how he designed his house to how he cooked and worked and went about his daily schedule. He motivated in me a desire to discover my own sense of passion through work. I began to travel overseas on surf trips and discovered writing, photography, storytelling.

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It has been almost nine years since I’ve touched ice now. I work as an independent journalist and writer, travelling and telling stories for various publications: The Australian, The Age, The Sydney Morning Herald.  It has taken an enormous amount of work, failed relationships, tears, isolation, and hard-earned wisdom to arrive at this point today.

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Drugs compound a problem but they are not the problem itself. Drugs are a response to a problem we do not know how to resolve.  And to truly resolve a drug addiction, we must address it at its deepest and most painful roots.  Many go through life and never do.  Anyone who has the strength a willpower to walk away from drugs does so only some kind of higher purpose: be it God, work, a family, a passion. Or just life itself.

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Words: Tom de Souza

This document helps you to be clear on what your drinking goals are. It helps you set the  boundaries you need to help you get to your goals. It works best if you can share them with a trusted person and have a self-imposed consequence should you break your own boundaries.

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Download the PDF:

Clean Slate Clinic - Goal setting.pdf

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Download the Word document:

Clean Slate Clinic - Goal setting.docx

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Preview:

If you’re preparing for a supported detox, or in the early days of one, you may be noticing things that feel unsettled. You may be feeling more anxiety, disrupted sleep, restlessness, low mood or just generally out of sorts. These are all very common feelings at this stage and are signs that your brain and body is beginning to readjust.

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Some people find it useful, comforting and reassuring to understand a bit of the science behind what’s going on in the brain during this time. This guide will explain the  ‘Neurochemistry in a Nutshell’ of how your brain is readjusting after stopping alcohol, why it can cause you to feel out of sorts and understand why it improves with time.

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Why does alcohol changes the way you feel?

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When alcohol enters the system, it affects four key brain chemicals (known as DOSE) – dopamine, oxytocin, serotonin and endorphins.

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Together, these chemicals regulate mood, motivation, social connection and pain response.

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Over time, regular alcohol use disrupts the brain’s ability to produce and regulate these chemicals naturally. The brain adapts to the presence of alcohol by dialling down its own production and, without alcohol, you may feel flat, anxious or disconnected. This isn’t a personal failing, it’s neuro-adaptation.

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Dopamine - Motivation and reward

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Dopamine acts like your brain’s cheerleader. Commonly known as the 'reward' neurotransmitter, it appears naturally when we accomplish something meaningful – like winning a race or reaching a goal. It signals pleasure, energy and confidence.

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Alcohol hijacks this reward system, delivering those feel-good sensations without any actual achievement. Unsurprisingly, this can leave you wanting more and more alcohol to keep your dopamine levels up.

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Over time, the brain reduces its own dopamine output, making everyday activities feel less rewarding. During recovery, this gradually reverses and natural sources of satisfaction become meaningful again.

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Oxytocin - Connection and trust

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Oxytocin is like your inner social butterfly – it makes you feel warm and fuzzy around others. When it’s boosted by alcohol, everyone at the party may feel like your best friend. That’s why someone might find themselves sharing their life story with strangers or sending an ill-advised "I love you" text to an ex – shudder.

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As the brain recalibrates, genuine connection, with people and with yourself, begins to replace the chemically simulated version. Many clients describe this as one of the most significant shifts.

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Serotonin - Mood and sleep regulation

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Serotonin is the brain’s mood regulator, influencing happiness, appetite, and sleep patterns.

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Alcohol temporarily raises serotonin, then drops it sharply, contributing to low mood and sleep disruption. In early recovery, serotonin levels stabilise and many report sleep quality is one of the first things to improve.

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Endorphins - Pain relief and wellbeing

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Endorphins are the natural painkillers and mood elevators produced by the body.

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Regular drinking suppresses the body’s natural endorphin production. The artificial stimulation of endorphins from alcohol can lead some people to develop dependence, as the brain begins to rely on drinking rather than natural sources of endorphins.

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During recovery, your body gradually restores its own capacity to manage discomfort and generate a sense of wellbeing.

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What this means in practice

The discomfort you may experience in early recovery, the anxiety, the flat mood, the restless nights, is your nervous system re-learning how to function without alcohol. It is temporary and it is a sign that recovery is working, not failing.

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What typically changes, and when?

Recovery is not a straight line and every person’s experience is different. There are patterns that we see consistently and knowing what to expect can reduce the uncertainty of this phase.

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Days 1–7: Stabilisation

The nervous system is in its most reactive state. Sleep disruption, anxiety and cravings are all very common and expected. This is the phase where medical supervision matters most and where detox-medication can significantly reduce discomfort. Your clinical team monitors you daily during this period.

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‍Weeks 2–4: Early adjustment

Sleep begins to improve. Energy-levels can fluctuate but gradually increase. Many people notice sharper thinking, reduced morning anxiety and the beginning of emotional clarity. This is also the phase where old habit loops are strongest, which is why structured clinical support continues.

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‍Months 2–3: Consolidation

Neurochemistry begins to normalise. Your dopamine and serotonin pathways in the brain return to a more normal, alcohol-free, baseline. Clients often describe this period as “the fog lifting.” Mood stabilises, relationships tend to improve and the cognitive bandwidth that alcohol consumed starts to become available for other things.

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‍Months 3–12: Restoration

The brain continues to heal and rewire. Research suggests significant neurological recovery occurs within the first year. The structured support in your programme (weekly, then monthly, then quarterly reviews) is designed to match the pace of this recovery, providing clinical support when the neurochemistry is most in flux and gradually stepping back as stability increases.

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CLINICAL NOTE

Brain imaging studies show measurable recovery of grey matter volume within weeks of stopping drinking. The cognitive and emotional improvements you notice are not placebo, they reflect genuine structural and functional changes in the brain.

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What supports this process

Your programme is designed to work with your brain’s recovery and not against it. But there are things that can meaningfully support the process alongside clinical care.

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Physical movement is one of the most effective natural D.O.S.E. boosters, even a daily walk generates dopamine and endorphins.

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Sleep hygiene matters more than usual during this period, as the brain does much of its repair work during deep sleep.

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Routine and structure reduce the cognitive load on a nervous system that is already working hard to recalibrate.

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Human connection even brief, low-stakes interaction, can support oxytocin production and reduces the isolation that often accompanies early recovery.

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These aren’t alternatives to clinical support, they are complements to it. Your clinical team can help you identify which ones are most realistic for your circumstances.

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QUESTIONS ABOUT WHAT TO EXPECT?

If this has raised questions and you want to talk to our team contact us at client.support.uk@cleanslateclinic.com

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Delay. Distract. Decide.  If you're struggling with cravings, try this approach to remove their power, allow them to pass, and stay focussed on the goals that matter to you.

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The 3Ds.pdf

Download PDF • 250KB

Cravings can be really challenging when you're trying to reset your relationship with alcohol, or any other substance, and can come out of nowhere when you least expect them, or appear at the familiar time when you were used to picking up a drink or other substance.  They can feel intense too.  The good news is that they do lessen over the time, and in the meantime there are lots of strategies you can deploy to manage and get through them.  Read our factsheet for some tips and tricks that will help you through.

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Clean Slate Clinic - Coping with cravings.pdf

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Read the full evaluation of our our program by Sydney University, demonstrating the high adoptability, acceptability and effectiveness of our model in successfully supporting individuals into recovery from alcohol dependence.

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Clean Slate Home Detox Evalution.pdf

The Clean Slate Clinic is designed by Dr Chris Davis – a full time GP with a special interest in alcohol and other drug treatment. He has been successfully delivering this evidence-based model from his GP clinics in London and Sydney for the past 10 years. The below resources will give you further insight into safely supporting your friend or family member through the Clean Slate Clinic program.

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Starting a conversation about alcohol - Hello Sunday Morning

If you’re impacted by someone’s drinking, or worry about their habits, you might want to read up on how to best assess if they would be open to change, and how to prepare to approach them.

Read the article

Thank you to the Alcohol and Drug Foundation for providing the following content on Alcohol and Thiamine. You can read the original article here.

Thiamine, also known as vitamin B1, is an essential nutrient used by the body to convert food into energy.  

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Thiamine takes the fats, proteins and carbohydrates we consume and uses them to fuel functions of the heart, nerves and brain.(1)

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Because the body cannot produce thiamine, it must be consumed through foods like:

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• whole grain products such as cereals, rice, pasta, and flour
• wheat germ
• beef and pork
• trout and bluefin tuna
• eggs
• legumes and peas
• nuts and seeds.(2)

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Smaller amounts of thiamine are present in fruit, vegetables and dairy products.(2)

Thiamine is also added to food products like bread and is available as a dietary supplement.(3)

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Thiamine deficiency

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Thiamine deficiency, although rare in most developed countries, is common in people who drink excessive amounts of alcohol.

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Up to 80% of people with an addiction to alcohol develop thiamine deficiency.(1)

Heavy alcohol use causes inflammation of the stomach lining and digestive tract, which reduces the body’s ability to absorb vitamins. Poor dietary choices and a lack of nutrition also rob the body of essential vitamins.(4)

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Thiamine deficiency can cause:

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• loss of appetite
• constipation
• fatigue
• blurry vision
• changes in heart rate
• irritability
• nausea and vomiting
• reduced reflexes and tingling sensation in the arms and legs
• shortness of breath
• muscle weakness.(1,5)

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Other people at risk of thiamine deficiency include older adults, people who’ve had bariatric (weight loss) surgery, and people with HIV/AIDS or diabetes.(1)

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What happens if I’m thiamine deficient?

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The early stages of thiamine deficiency often go undiagnosed as the initial signs – decreased appetite, constipation and fatigue – are non-specific. If the body continues to experience a lack of thiamine absorption, it can lead to serious health conditions including beriberi and Wernicke-Korsakoff syndrome. Both conditions can be fatal if not treated.(1)

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Beriberi

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There are two types of beriberi - wet beriberi and dry beriberi.(6)

Wet beriberi affects the heart and circulatory system and in extreme cases can cause heart failure.(6)

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Dry beriberi damages the nerves and can lead to decreased muscle strength and eventually, muscle paralysis.(6)

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Wernicke–Korsakoff’s syndrome

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Wernicke-Korsakoff’s syndrome most commonly occurs in alcohol-dependent people.

This nerve and brain disease is made up of two conditions/phases – Wernicke encephalopathy, which occurs first and then progresses to Korsakoff’s syndrome.(1)

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Wernicke’s encephalopathy is life threatening. Symptoms include:

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• confusion
• loss of memory activity
• loss of muscle coordination and leg tremors
• double vision, abnormal eye movements or eyelid drooping.(1,4)

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Wernicke’s encephalopathy is usually reversible through treatment but can progress to Korsakoff’s syndrome - a chronic and disabling condition characterised by severe short-term memory loss, hallucinations and impaired ability to acquire new information.(1)

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Treating thiamine deficiency

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Thiamine deficiency can be treated by stopping alcohol consumption, eating a nutritious diet and by taking vitamin B1 supplements.(1)

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However, diet and supplements alone are not effective if heavy alcohol use continues because alcohol will block absorption.

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If you’re concerned about vitamin depletion as a result of drinking alcohol, talk to your health professional.

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References

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1. National Institute of Health (NIH). Thiamin [Accessed 27 October 2021].
2. Medline Plus. Thiamin [Accessed 27 October 2021].
3. Food Standards Australia New Zealand. Thiamin levels in Australian breads: Results from the 2010 and 2012 national bread surveys Food Standards Australia New Zealand [Accessed 27 October 2021].
4. Medline Plus. Wernicke-Korsakoff syndrome [Accessed 27 October 2021].
5. Healthline. 11 Signs and Symptoms of Thiamine (Vitamin B1) Deficiency [Accessed 27 October 2021].
6. National Health and Medical Research Council (NHMRC). Thiamin [Accessed 27 October 2021].