The Coleman Institute for Addiction Medicine Blog
7
Aug 23
August 7, 2023
The Dangers of Alcohol-Induced Psychosis
Hearing voices, seeing things that others cannot see, or feeling convinced someone is trying to harm you can be super frightening. When these experiences develop during heavy drinking or after cutting back, alcohol may be contributing to a condition called alcohol-induced psychosis.
These symptoms need prompt medical attention. Alcohol-related hallucinations can overlap with dangerous withdrawal complications and other medical conditions, making it vital to get an assessment rather than trying to ‘wait them out’.
If hallucinations develop during or after heavy drinking, go to an emergency department or call 911. Seizures, fever, severe confusion, or an irregular heartbeat also require emergency care. Do not drive yourself.
What Is Alcohol-Induced Psychosis
Alcohol-induced psychosis, also known as alcoholic psychosis or alcohol-related psychosis, is a type of substance-induced psychotic disorder involving hallucinations, delusions, or both in connection with alcohol intoxication or withdrawal. These symptoms can affect a person's ability to distinguish what is real from what they are experiencing.
You may also see the term alcoholic hallucinosis, also called alcohol hallucinosis. This describes alcohol-associated hallucinations that occur while a person remains relatively alert and aware of their surroundings. A healthcare professional must evaluate the symptoms and their timing to determine whether alcohol is responsible or another condition is contributing.
What Causes Alcohol-Related Psychosis
Repeated heavy drinking changes how the brain responds to alcohol and introduces the risk of alcohol-related psychosis. As the nervous system adapts, suddenly stopping or substantially reducing alcohol can leave the brain overly active; the resulting group of symptoms is called alcohol withdrawal syndrome.
Common alcohol withdrawal symptoms include shaking, sweating, nausea, anxiety, and trouble sleeping. Some people also develop hallucinations or other serious complications. However, alcohol-induced psychosis can also develop in connection with heavy drinking itself.
Symptoms often emerge in the days after reducing or stopping alcohol use, but timing alone cannot identify the cause; important factors include when symptoms began, when alcohol was last used, and whether other substances or medications are involved.
If you find it difficult to control your drinking, experience strong cravings, or continue drinking despite the problems it brings to your life, these unfortunately, may be signs of alcoholism. A clinician can assess for alcohol use disorder and help determine if medical detox is needed.
Symptoms of Alcohol-Induced Psychosis
Hallucinations and delusions are the main symptoms of alcohol-induced psychosis.
Hearing voices or sounds that aren't there.
Voices may seem critical, threatening, or directed specifically at the person.
Seeing or feeling things that others do not.
A person may see figures or objects that are not there, or experience unexplained sensations on their skin.
Strong beliefs that are disconnected from reality.
Someone may feel certain they are being watched, followed, or threatened, even though it is untrue.
Anxiety, disrupted sleep, or withdrawal from other people may accompany psychotic symptoms. A person may have difficulty recognizing that their perceptions or beliefs are symptoms of an illness.
Severe confusion, difficulty staying alert, or not knowing where they are can signal delirium or another medical emergency; these changes need immediate evaluation.
Alcoholic Hallucinosis Versus Delirium Tremens
Alcoholic hallucinosis and delirium tremens are different conditions, although both can involve hallucinations.
Someone with alcoholic hallucinosis may know where they are and follow a conversation while experiencing hallucinations. Delirium tremens, also called DTs or alcohol withdrawal delirium, involves a serious disturbance in attention and awareness.
|
Alcoholic Hallucinosis |
Delirium Tremens |
| May remain alert and oriented | Confusion, disorientation, and changing alertness |
| Hallucinations, sometimes with delusions |
May include hallucinations, body tremors, severe agitation, fever, and heavy sweating |
| Urgent evaluation; hospitalization may be needed |
Emergency treatment required |
DTs can be life-threatening. Appearing alert does not make alcohol-related hallucinations safe to manage at home, and families should not try to remedy these conditions without medical intervention.
Why Alcohol-Induced Psychosis Is Dangerous
The immediate concern is how symptoms affect a person's safety. Hearing voices can cause intense distress and interfere with judgment, increasing the risk of accidental injury or self-harm. Medical intervention can reduce these risks.
Symptoms can also make it harder to trust loved ones, communicate clearly, or accept the care that they need. Someone who believes they are being threatened or in danger may withdraw from their support system, the people trying to help them.
Another concern is missing a different medical problem. Hallucinations or changes in behavior may be related to severe withdrawal, a head injury, seizures, or liver-related brain dysfunction (Hepatic Encephalopathy). Assuming alcohol is the only explanation for these concerns can delay the necessary treatment.
Treatment for Alcohol-Induced Psychosis
Treatment begins with a comprehensive medical assessment to identify the cause of the symptoms, address immediate risks, and determine the right level of care.
Medical Evaluation & Stabilization
Clinicians review drinking patterns, previous withdrawal episodes, mental health history, medications, and other substance use. A physical examination and additional testing may help identify dehydration, blood sugar problems, nutritional deficiencies, or another condition requiring treatment.
People with active psychosis or complicated withdrawal may need to be hospitalized for close observation and treatment.
Alcohol Withdrawal Management
For someone who is physically dependent on alcohol, abruptly stopping without medical support can be dangerous. Alcohol withdrawal management usually involves medication, monitoring, and nutritional support based on the person's circumstances.
Benzodiazepines are commonly used alcohol withdrawal medications that help manage symptoms and reduce the risk of seizures and delirium. Thiamine, also called vitamin B1, is often provided to help prevent a separate neurological complication called Wernicke encephalopathy.
Some people also need psychiatric care and antipsychotic medication. When alcohol withdrawal is present, antipsychotics do not replace appropriate withdrawal treatment. Medication choices are based on the patient and require individual medical supervision.
Continued Treatment After Detox
Detox addresses withdrawal, but ongoing care helps a person maintain recovery and manage the factors that contribute to drinking. A plan may include counseling, medication for alcohol use disorder, and peer support, such as Alcoholics Anonymous. Co-occurring mental health conditions also need to be addressed.
At The Coleman Institute, we generally recommend oral naltrexone to our patients after an alcohol detox, or its injectable form, Vivitrol, and Antabuse as a part of their recovery aftercare plan.
How Long Does Alcohol-Induced Psychosis Last
Recovery from alcohol-induced psychosis varies from person to person. Symptoms often improve with medical treatment and continued abstinence, but some people experience persistent hallucinations or recurring episodes, especially if drinking resumes. Follow-up care is important even after the immediate crisis has passed.
It’s important to note that alcohol-induced psychosis and schizophrenia are separate diagnoses. Experiencing psychosis does not automatically mean someone has schizophrenia. If symptoms continue after alcohol withdrawal has resolved, clinicians need to reassess for an ongoing alcohol-related condition, an independent psychiatric disorder, or another medical cause.
Helping Someone Experiencing Alcohol-Related Hallucinations
If a loved one starts hallucinating during or after heavy drinking, help them get emergency medical care. Stay with them if you can do so safely, and do not let them drive. If there is an immediate risk of injury or self-harm, call 911.
Share what you know with the medical team, including their usual drinking pattern, recent changes in alcohol use, and any history of withdrawal seizures or DTs. This information helps providers assess the situation and plan treatment.
Outpatient Alcohol Detox at The Coleman Institute
If you are concerned about your drinking and want help stopping, The Coleman Institute offers medically supervised outpatient detox for alcohol in as little as three days. Our medical team evaluates each patient's needs to determine whether outpatient care is appropriate. But active psychosis or severe withdrawal requires emergency assessment and may require hospital treatment before outpatient care can be considered.
Following detox, eligible patients may benefit from naltrexone therapy. Naltrexone is a non-addictive medication that can help reduce alcohol cravings post-detox. Keep in mind, does not treat acute alcohol withdrawal or replace treatment for psychosis by itself.
For more about withdrawal and treatment for alcoholism, explore our Guide to Understanding Alcohol Detox!
Call The Coleman Institute at 877-773-3869 for a free, confidential consultation about alcohol detox and discover your treatment options.
This article is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Do not begin, change, or stop any medication without guidance from a qualified healthcare provider.
17
Jul 23
July 17, 2023
Freakin’ Fentanyl
Oscar* is 26 years old, has a girlfriend of five years and a one-year-old son. He has worked for a well-known delivery company for the better part of four years and has excellent insurance and benefits. Several months ago, he was physically dependent on fentanyl.
When Oscar called the Coleman Institute for Addiction Medicine in Richmond, Va., he told me that he had ‘played around’ with opioids in his teenage years, taking a Percocet or two at parties, and of course, his friends always knew there would be hydrocodone to share whenever anyone had their wisdom teeth removed. He smoked a little cannabis and drank some beer, but rarely overdid it. He was the guy who always had a job and was always a very reliable employee.
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11
Jul 23
July 11, 2023
What Is Lean? Understanding Purple Drank
Lean, also known as purple drank, sizzurp, dirty Sprite, barre, or simply syrup, is a recreational drug made by mixing prescription cough syrup containing codeine and promethazine with a soft drink, most commonly Sprite or other lemon-lime soda, and sometimes adding hard candy like Jolly Ranchers for flavor.
Lean’s primary ingredient, codeine, is an opioid; it can lead to physical dependence, addiction, overdose, and other serious health complications.
Over the past two decades, lean has become increasingly recognized through music, social media, and pop culture, normalizing use and making it seem like a relatively harmless way to get high. But in reality, repeated use can change how the brain responds to opioids, making it difficult to stop without experiencing withdrawal symptoms.
Whether you're concerned about your own use, worried about a loved one, or simply trying to understand the risks, learning how lean affects the body is very important.
What Is Lean?
Lean is a recreational beverage made by combining prescription cough syrup containing codeine and promethazine with soda. Some people also add candy for taste.The exact recipe can vary, but traditional lean typically contains prescription cough syrup with codeine and promethazine and lemon-lime soda such as Sprite.
Today, some versions may contain different medications or substances depending on what is available. This makes the strength and potential dangers even more unpredictable. For example, some variants may contain guaifenesin.
Although it is consumed as a drink, lean is considered an opioid drug because of the codeine it contains.
What's In Lean?
Codeine
Codeine is a prescription opioid commonly used to treat pain and suppress coughing. After it is swallowed, the liver converts part of the codeine into morphine, allowing it to activate the brain's mu-opioid receptors.This can produce effects such as relaxation, euphoria, pain relief, drowsiness, and slowed breathing.
Just like other opioids, repeated codeine use can lead to tolerance, dependence, and addiction.
Promethazine
Promethazine is an antihistamine commonly prescribed for allergies, nausea, and motion sickness. It is also highly sedating.When combined with codeine, promethazine can increase sleepiness and dizziness, impair coordination, and slow reaction time.
The combination of these two medications significantly increases central nervous system depression.
Soda
The soda does not contribute to the drug's psychoactive effects. Instead, it helps mask the medicinal taste of the cough syrup.How Does Lean Affect the Brain?
The primary psychoactive ingredient in lean is codeine.Once converted into morphine, codeine binds to mu-opioid receptors throughout the brain and spinal cord. Activating these receptors changes how the body experiences pain while also increasing dopamine release within the brain's reward system.
This can produce temporary feelings of relaxation and euphoria, but it also slows activity throughout the central nervous system.
As a result, lean may cause:
- Drowsiness
- Slowed breathing
- Reduced heart rate
- Poor coordination
- Slower reaction times
- Impaired judgment
Why Do People Drink Lean?
People use lean for many different reasons. Many are initially attracted by curiosity or influence, especially with popular artists like Lil Wayne and Soulja Boy making songs about it.While some people only experiment with lean occasionally, others begin using it more frequently because they enjoy how it makes them feel.
Over time, recreational use can gradually become physical and psychological dependence, meaning a person begins drinking lean simply to avoid withdrawal symptoms rather than to get high.
Is Lean Addictive?
Yes. Lean can absolutely become addictive.Because it contains codeine, repeated use can cause the brain to adapt to the presence of opioids. As this happens, people often develop tolerance, meaning they need larger amounts to achieve the same effects.
Eventually, the brain may begin relying on codeine to function normally. At this stage, suddenly stopping lean can trigger opioid withdrawal symptoms.
Not every single person who drinks lean develops an addiction. However, the risk increases with:
- Frequent use
- Larger doses
- Long-term use
- Mixing lean with other drugs
- History of substance use disorders
Signs of Lean Addiction
Lean addiction often develops gradually over time.Common warning signs include:
- Needing increasing amounts to achieve the same effects
- Craving lean throughout the day
- Trying unsuccessfully to quit
- Spending excessive money on cough syrup
- Continuing to use despite problems it's causing
- Using lean simply to avoid feeling sick
- Experiencing withdrawal symptoms when not using
Lean Withdrawal Symptoms
Because codeine is an opioid, lean withdrawal closely resembles withdrawal from other short-acting opioids.Symptoms often include:
- Anxiety
- Restlessness
- Muscle aches
- Sweating
- Chills
- Goosebumps
- Runny nose
- Nausea
- Vomiting
- Diarrhea
- Insomnia
- Dilated pupils
- Cravings
For many people, withdrawal becomes the biggest obstacle to quitting. After withdrawal symptoms begin, it is common for someone to relapse simply to stop feeling sick, reinforcing the cycle of dependence.
Can You Overdose on Lean?
Yes. Because lean contains an opioid, taking large amounts or combining it with other substances can cause a life-threatening overdose.Signs of a lean overdose may include:
- Very slow or stopped breathing
- Extreme drowsiness
- Inability to wake up
- Blue lips or fingertips
- Pinpoint pupils
- Loss of consciousness
If someone is experiencing a suspected opioid overdose, call 911 immediately. Because codeine is an opioid, naloxone (Narcan) may help reverse the overdose while emergency medical care is on the way.
Long-Term Effects of Lean Abuse
Repeated lean use can affect nearly every aspect of a person's health and daily life.Potential long-term effects include:
- Opioid use disorder
- Chronic constipation
- Liver damage
- Hormonal changes
- Cognitive impairment
- Depression
- Increased overdose risk
Why Quitting Lean Can Be So Difficult
Many people assume they can simply stop drinking lean whenever they choose.Unfortunately, once physical dependence develops, quitting is often much more complicated.
Rather than using lean to relax or feel euphoric, many people eventually continue using it simply to prevent withdrawal symptoms.
This creates a difficult cycle:
- Stop using.
- Withdrawal begins.
- Symptoms become unbearable.
- Use lean again to feel normal.
- The cycle repeats.
Why Accelerated Opioid Detox May Be a Good Option
One of the biggest reasons people delay seeking treatment is fear of withdrawal.Many individuals know they want to stop using lean but worry about becoming sick, missing work, or being away from their families during treatment.
Because lean contains codeine, a relatively short-acting opioid, many people may be candidates for our accelerated outpatient opioid detox program.
At The Coleman Institute, patients undergo a comprehensive medical evaluation to determine whether accelerated detox is appropriate for their individual situation. Treatment is physician-supervised and designed to help reduce the discomfort associated with opioid withdrawal while allowing many patients to quickly return to their everyday lives.
Unlike traditional inpatient programs that may require weeks or even months away from home, our accelerated opioid detox can be completed in as little as 3 days.
Each patient's treatment plan is different, and factors such as the amount of lean used, duration of use, overall health, and whether other substances are involved all contribute to the detox process.
The earlier opioid dependence is treated, the easier it often is to manage before it progresses further and spirals out of control.
Our Abstinence-Based Approach to Opioid Addiction
Many treatment providers manage opioid dependence by prescribing long-term opioid replacement medications such as Suboxone or methadone.While these medications may be appropriate for some individuals, The Coleman Institute follows an abstinence-based philosophy whenever medically fit.
Our goal is to help patients become completely free from opioid dependence rather than replacing one opioid with another.
Following detox, patients are recommended naltrexone therapy, including monthly Vivitrol injections if deemed appropriate by the provider. Unlike opioid replacement medications, naltrexone is non-addictive, contains no opioids, and may help reduce cravings while lowering the risk of relapse.
Combined with counseling, recovery support, and individualized aftercare planning, this comprehensive approach helps patients build a solid foundation for long-term sobriety.
When Should You Seek Treatment for Lean Addiction?
If you're asking yourself whether your lean use has become a problem, it's worth speaking with a medical professional.Treatment may be appropriate if you:
- Experience withdrawal symptoms when you stop using
- Need increasing amounts to feel the same effects
- Have tried unsuccessfully to quit
- Continue using despite negative consequences
- Mix lean with alcohol or other drugs
- Have experienced an overdose or close call
Frequently Asked Questions
Is lean an opioid?
Lean itself is a mixture of ingredients, but because it contains codeine, it does contain an opioid.Is purple drank the same as lean?
Yes. Purple drank, lean, sizzurp, dirty Sprite, barre, and syrup are all common names for the same recreational drink.Can you become addicted to lean?
Yes. Repeated use can lead to tolerance, dependence, and addiction.How long does lean stay in your system?
This varies depending on factors such as dosage, metabolism, liver function, and frequency of use. Codeine may be detectable for several days after use, although its effects wear off much sooner.Can you overdose on lean?
Yes. Because lean contains codeine, taking too much, or combining it with alcohol or other downers, can cause respiratory depression, overdose, and death.Can you detox from lean at home?
Some people attempt to quit on their own, but the withdrawals often lead to relapse. Speaking with a medical professional can help determine the safest treatment approach based on your situation.Can Narcan reverse a lean overdose?
Because codeine is an opioid, naloxone (Narcan) may reverse the opioid effects during an overdose. However, emergency medical care should always be sought immediately by calling 911.Get Help for Lean Addiction
If you or someone you love has become dependent on lean, know that recovery is possible.The Coleman Institute for Addiction Medicine provides an innovative outpatient treatment for opioid dependence, including addiction involving codeine-containing cough syrup. Our team can evaluate your situation, answer your specific questions, and determine whether accelerated opioid detox is an appropriate treatment option.
You don't have to continue living around your next dose. Taking the first step today can be the beginning of your lasting sobriety.
27
Jun 23
June 27, 2023
How Long Do Opioids Stay In Your System?
Opioids encompass a wide range of substances, including powerful prescription medications like fentanyl, oxycodone and hydrocodone, as well as illicit drugs such as heroin or street fentanyl. Each opioid has unique characteristics, including varying half-lives and rates of metabolism, which affect the duration of its presence in the body.
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15
May 23
May 15, 2023
Signs of Alcohol Addiction: When It’s Time to Seek Help
Alcohol is a widely accepted and often celebrated substance, but it can also be addictive and harmful. If you are struggling with alcohol use, it may be difficult to recognize when it's time to seek help. However, acknowledging the problem and seeking treatment is the first step towards recovery. This article will explore the signs that indicate it's time to seek help for alcohol addiction and answer some common questions about alcohol addiction treatment.
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