Treatment for Lean “Purple Drank” Addiction

Reading Time: 7 minutes

Cough medications are among the most misused drugs among all psychoactive substances¹ (those that affect the brain or nervous system). Lean (or purple drank) is one such drug that you or a loved one may be using. If your use is becoming abuse or addiction, it’s essential to get treatment for lean addiction before it’s too late.

When Should I Seek Treatment for Lean Addiction or Misuse?

When considering whether it’s time to find treatment for lean misuse, you should ask yourself the following questions:

• Do you often use lean in significant amounts or over longer periods than you originally intended?
• Have you tried to cut down on your use and have been unsuccessful?
• Do you have intense cravings or urges to use lean?
• Has lean use gotten in the way of fulfilling school or work responsibilities?
• Have you put yourself in physically hazardous situations, such as driving, while intoxicated from lean?
• Have you continued to use Lean despite it causing problems in your life or to your health?
• Have you experienced lean withdrawal symptoms?
• Have you needed to use larger and larger amounts of Lean over time to achieve the desired effect?

If you answered yes to any of these questions, seeking help is strongly recommended.

Seeking the right professional help is critical for lean addiction treatment, no matter the level of use. It is important to find the right providers to meet your or your loved one’s needs. For 24/7 addiction help, call 800-681-1058 (Who Answers?) and speak to a treatment specialist.

Steps to Getting Treatment for Lean Addiction

Step 1: Ask About Treament for Lean Addiction

Speak with your primary care doctor or call 800-681-1058 (Who Answers?) to speak to a treatment specialist about your desire to seek treatment. Given that your doctor knows your medical history, you and your doctor can work together to determine what type of treatment may best suit your needs.

Step 2: Call Your Health Insurance Company

Contact your health insurance company regarding costs. Some questions that will be helpful to jot down before calling are:

• What types of substance use treatment does my plan cover (inpatient, outpatient, residential rehabilitation)? How do you decide what is covered?
• What are my co-pay and other out-of-pocket costs?
• Can you provide me a list of therapists or treatment centers that accept my insurance plan?

Step 3: Choose the Right Rehab

Choose the right psychotherapists or treatment centers based on quality, location, and cost. Therapists should be licensed in the state where you reside and be qualified to assess and treat substance use issues. Some questions you can ask providers are:

• Are you qualified to assess and treat substance use issues?
• What are your credentials? What do they mean? Are you licensed where I live?
• What types of therapy do you provide? Individual? Family? Group?

Step 4: Be Prepared

Know what to expect when you first meet with a provider. In general, the process is:

• An intake assessment is conducted to ask questions about yourself, the amount of lean use you have, and you may need to complete symptom questionnaires and other paperwork.
• You will then receive feedback from the therapist about their clinical impressions on your level of use and lean treatment needs.
• The therapist will present a treatment plan based on their assessment, which includes what type of treatment setting best meets your needs.

Recommended Treatment for Lean Addiction

Depending on your level of lean use, inpatient, residential rehab, or outpatient treatment may be recommended.

Inpatient Treatment

Inpatient treatment usually involves a hospital stay for about 3-7 days. This is generally recommended if your body needs detoxification (detox) from lean or if you have other significant physical or mental health conditions.

Inpatient treatment may include medication and/or individual or group therapy. Upon discharge, you would be provided instructions and referrals for your next stage of recovery.

Residential Rehab

Residential rehab will be the right place for you if you lack social support or have had unsuccessful attempts to cut down or stop your use of lean. This stay is usually about 1-3 months.

Outpatient Treatment for Lean Addiction

Outpatient treatment is working with a therapist in individual, group, or family therapy about 2-4 times per month. This would be a fit for you if:

• You have strong social supports
• Your lean use is at a more mild or moderate level
• You are functioning fine overall

Treatment may include cognitive behavioral therapy (CBT) in an individual and/or group counseling setting. CBT is effective in changing thinking and decision-making regarding drug use and identifying and managing triggers for use.

What Can I Do as a Parent to Help My Teenager?

Adolescence is a time when children are starting to become independent and developing their own identities. However, they are still young enough to need their parents, which can often lead to push-pull dynamics between parents and children.

As a parent, you may notice that your child rejects your suggestions or even pushes you away when you try to help while also pulling at you to meet his or her other needs.

Similar dynamics may play out when you try to talk with your adolescent about substance use. Compared to childhood, your teen may be more ready to consider various pieces of information and process them before making a decision. Therefore, they need to share their thoughts and experience in addition to learning from you.

A two-way, open conversation, rather than a lecture, may be the best way to help them avoid or quit substance use.⁷ Here are some things to consider doing when talking with your teen:

• Remain calm and take a genuine interest in what your child says.
• Ask open-ended questions such as “what have you heard about how Lean affects the body?” or “what have your classmates said about Lean?”
• Provide balanced information about lean. Acknowledge how it can be appealing and then provide information on its negative impacts.
• If you can’t answer a question(s) your child has, try to research them together.

If you are struggling to communicate with your teen or are concerned your child may be using lean, and you would like help in addressing the issue, reach out to a licensed therapist, ideally, one specializing in substance use issues.

What is Lean (Purple Drank)?

Prescription cough syrup mixed with soda or alcohol is commonly known as lean, purple drank, or sizzurp.

Lean is made by mixing soda with cough syrup that contains codeine. Another version of lean or purple drank is a cough syrup (containing both promethazine and codeine) mixed with alcohol. Those who use lean may also flavor the drink by adding hard candies such as Jolly Ranchers.²

The lean drug (or lean drink) has become more commonly misused by teenagers; they refer to it as “Robotripping.” Teens may also say “leaning on syrup” or “gonna go get me some syrup.” ³ Some other streets names for Lean include:

• Purple drank
• Sizzurp
• Double cup
• Skittles
• Orange crush
• Dex
• Red devils
• Velvet⁴

Effects of Lean on the Body

Codeine is an opioid with cough-suppressant effects, and promethazine is an antihistamine that acts as a sedative. Medications containing codeine are often used to achieve relaxation and euphoria (intense happiness and feeling carefree). In a single dose, it is sedating. But some who have used purple drank have reported that, with repetitive doses, it tends to be energizing.¹

Opioid overdose can lead to:¹

• Decreased consciousness (or coma)
• Abnormally slow or ceased respiration
• Pinpoint pupils

Misuse of opioids over the long term could lead to physical and psychological dependence, tolerance, and withdrawal symptoms such as:¹

• Agitation
• Diarrhea
• Insomnia
• Muscle cramps
• Panic attacks
• Sweating

Promethazine is usually taken in larger amounts for the calming effects or ability to induce euphoria and hallucinations. It is known to be misused by:⁵

• Teenagers and young adults
• People dependent on opioids
• Heroin users
• Chronic pain patients who are prescribed opioids
• Those who have another substance use condition

Cough syrup containing both promethazine and codeine is often mixed with alcohol, candy, and soda. Some consequences of this mixture include:

• Arrhythmia (irregular, too fast, or too slow beating of the heart)
• Psychosis (delusions, hallucinations, agitation, talking incoherently)
• Delirium (confusion, hallucinations, reduced awareness of surroundings)
• Tardive dyskinesia (repetitive and involuntary movements)¹

The effects of lean on adolescents are particularly concerning. Adolescence is when the brain continues to develop, and misuse of substances can hinder that development.

At the same time, adolescents are more vulnerable to substance use and its effects because parts of the brain active in rewarding develop before the parts that are active in planning and decision-making.

Additionally, adolescent misuse of codeine cough syrup can sometimes lead to opioid abuse. A risk factor for illicit drug use among adolescents is dropping out of high school.⁶

References

1. Sobczak, L. & Gorynski, K. (2020). Pharmacological aspects of over-the-counter opioid drugs misuse. Molecules, 25,1-13.
2. Mooney, L. (2015). Drugs of abuse: What you and clinicians need to know.
3. Tettey, N., Siddiqui, K., Llamoca, H. Nagamine, S. & Ahn, S. (2020). Purple drank, sizurp, and lean: Hip-hop music and codeine use, a call to action for public health educators. International Journal of Psychological Studies, 12(1),42-52.
4. Denke, N. (2019). It’s over the counter so it must be safe.
5. Chiappini, S., Schifano, F., Corkery, J.M. & Guirguis, A. (2021). Beyond the ‘purple drank’: Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports. Journal of Psychopharmacology, 1-12.
6. Kulak, J.A. & Griswold, K.S. (2019). Adolescent substance use and misuse: Recognition and management. American Family Physician, 99(11), 689-696.
7. Carver, H., Elliott, L., Kennedy, C. & Hanley, J. (2017). Parent-child connectedness and communication in relationship to alcohol, tobacco and drug use in adolescence: An integrative review of the literature. Drugs: Education, Prevention and Policy, 24(2), 119-133.