Lean addiction: definition, symptoms, and causes

Lean addiction is the compulsive need to keep using lean drinks despite the harmful consequences it causes. Also known as the purple drank, it is popular among teens and young adults. Lean ingredients are codeine-containing syrup, hard candy, soda, antihistamine promethazine, and sometimes alcohol.

Symptoms of lean addiction are increased tolerance, relationship problems, health problems, financial difficulties, compulsive drug-seeking behavior, loss of control, withdrawal symptoms, physical and psychological dependence, neglecting responsibilities, and behavioral or mood changes.

Causes of addiction to lean syrup are the euphoric effects of prescription opioids in the concoction, tolerance to the opioid, genetics, and the environment. Medical conditions that cause lean addiction include chronic pain, substance use disorders, underlying medical conditions, mental health disorders, and co-occurring substance use.

Lean addiction treatments include detoxification, inpatient and outpatient programs, and support groups.

What is lean addiction?

Lean addiction is a persistent desire to consume lean drinks despite the problems it causes. Lean is a recreational and highly addictive drug beverage made from cough syrup (codeine), soda drinks, and hard candy. Codeine is a Schedule II/IIN controlled substance due to a risk of addiction and misuse and it is one of the most commonly used opioids. Besides codeine, for the purpose of making lean drinks, people tend to use cough syrups containing dextromethorphan or promethazine. Lean is a homemade drug and its name derives from the effect it exhibits on users i.e. it causes drowsiness and loss of balance, thereby making a person lean against something (e.g. wall) to avoid falling.

Lean addiction isn’t described as a specific substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association, but opioid addiction is. This is important because codeine, mostly used to make lean drinks, is a prescription opioid. Opioid use disorder is included in DSM-5.

History of lean dates back to the 1960s when blues musicians in Houston, Texas combined a cough syrup Robitussin with beer. Later, beer was replaced with wine coolers. The practice of using this concoction was also adopted by generations of rappers. However, in the 1980s and 1990s, the formula of this beverage changed. At that point, codeine became the main ingredient. For many years, drinking lean was a local practice. In the 1990s, an American rapper called DJ Screw released several tracks that mentioned lean drinks. Rappers outside Houston adopted this lifestyle and the popularity of lean moved past city limits, it spread to other cities and states in the south of the United States. The use of lean was never stigmatized in Houston, until DJ Screw’s death, which was related to the consumption of this concoction. Law enforcement became interested in lean drink and imposed felony charges for some aspects surrounding it.

What is the other term for lean addiction?

The other term for lean addiction is, actually, a different term for this drink, and it is purple drank or sizzurp. Other names for lean are purple tonic, syrup, sip-sip, dirty Sprite, barre, drank, purple jelly, wock, wok, Memphis mud, Texas tea, purple stuff, oil, player potion, and purp. The color purple dominates in names for lean because that is how the liquid looks when all ingredients are combined. 

How common is lean addiction?

It’s not entirely clear how common is lean addiction because information surrounding this type of addiction is scarce. Around 15.5% of 1029 EDM (electronic dance music) party attendees have ever used lean, according to a study that Dr. Joseph J. Palamar from New York University Langone Medical Center New York published in the September 2019 issue of the American Journal on Addictions. Of all participants who used lean, 3.4% of attendees consumed it in the past year. Only around 0.2% of participants used it in the past month, but 14.2% would use it the next month if a friend offered it. Other findings show three-quarters of subjects (75.4%) believed their lean ever contained codeine whereas 32.4% believed it always or usually contained codeine.

A paper by L.E. Agnich et al. in the September 2013 issue of Addictive Behaviors reported that among a sample of 2349 students, 152 (6.5%) confessed having ever used lean drink. The use of lean was more common among males than females. The proportion of males that consumed lean at least once was two times higher than that of females (9.3% vs. 3.9%). The use of lean was more common in Hispanics (15.6%) and Native Americans (16.7%) than in Asian Americans (5.1%), African Americans (5.4%), and Whites (6.1%). People raised in major urban environments reported more use (12.2%) than their counterparts who were raised in suburban communities or moderate-sized cities (7.3%). The use of lean was lowest in rural areas (4.0%).

When it comes to lean addiction, it’s important to mention that codeine dependence is around 4% among adolescents, according to a paper by D. O’Reilly et al. in the December 2015 issue of BMJ Case Reports.

What are the causes of lean addiction?

The causes of lean addiction are listed below:

• Euphoric effects of prescription opioids in this concoction: upon consumption of lean, the drink acts on the brain’s reward system and produces pleasurable effects. These pleasurable effects include relaxation, stress relief, and sleepiness. A person may feel rewarded for drinking lean and start using it more frequently, which can lead to addiction. Codeine in lean drinks, which is an opioid, triggers the release of endorphins, feel-good chemicals in the brain. Endorphins may boost feelings of pleasure thereby creating a temporary, but powerful sense of well-being. This can also cause lean addiction.

• Tolerance to the opioid: with repeated use of lean drinks, a person builds tolerance to the main ingredient – usually codeine. That means they no longer experience the pleasurable effects of the substance. To feel relaxation and stress relief again, a person increases the amount of beverage they drink. Once they build a tolerance to that specific amount, they drink more. This paves the way to addiction to lean drinks.

• Genetics: a person can have a genetic predisposition to developing substance abuse. That means it is possible to inherit genes or gene variations that make a person more susceptible to becoming addicted to substances such as lean. 

• Environment: a person’s environment is a major contributor to the development of addiction. Adverse childhood experiences, trauma, or socializing with people who abuse the specific drug can increase one’s exposure to it and lead to dependence. 

What are the medical conditions that can cause lean addiction?

Medical conditions that can cause lean addiction are listed below:

• Chronic pain
• Substance use disorders
• Mental health disorder
• Underlying medical conditions
• Co-occurring substance use

1. Chronic pain

Chronic pain is pain that lasts longer than 12 weeks or three months despite treatment or medication. Pain is present all the time, or it comes and goes. According to the CDC, chronic pain is a debilitating condition that affects millions of people in the U.S. More precisely, around 51.6 million, or 20.9% of U.S. adults experienced chronic pain in 2021. Of these, 17.1 million, or 6.9% experienced high-impact chronic pain.

Examples of chronic pain, which comes in different forms and can affect any part of the body, including arthritis or joint pain, neck pain, back pain, cancer pain near a tumor, headaches and migraines, testicular pain, persistent pain in scar tissue, muscle pain including fibromyalgia, and neurogenic pain.

Chronic pain is a medical condition that can cause lean addiction because it also comes with emotional distress, all of which can dysregulate the brain’s reward circuitry thereby increasing the risk of opioid use disorder, according to the National Institute on Drug Abuse. Codeine, the main ingredient in lean drink, is an opioid that has the potential to alleviate mild to moderate pain. In addition to acting on the reward system, chronic pain is a cause of lean addiction because people may use the drink to relieve the pain they’re experiencing. The pain-relieving effects are short-term or temporary, which may motivate a person to keep using the drink again.

2. Substance use disorders

Substance use disorders (SUDs) are complex conditions indicated by uncontrolled use of a substance despite harmful consequences. Individuals with SUD have an intense focus on a certain function and experience a strong urge to use it to the point their daily life becomes impaired, according to the American Psychiatric Association.

Examples of substance use disorders are addictions involving alcohol, heroin, prescription and over-the-counter (OTC) medications, cocaine, marijuana, methamphetamine, LCD, and other hallucinogens, inhalants, or club drugs.

Substance use disorders become a medical cause of lean addiction because people may consume this beverage in an attempt to achieve the same effect they experience with the specific substance to which they are addicted. Also, addiction replacement is an option. That means a person tries to recover from one SUD by using a different substance and eventually becoming addicted to it. Addiction replacement or substitution is done to fill an emotional or psychological void.

3. Mental health disorder

Mental health disorder is a health condition indicated by changes in emotion, behavior, and thinking patterns (or a combination of all of them). It is associated with distress or impairment in important areas of functioning. When discussing mental illness, it’s also important to mention that in 2019, one in every eight individuals or 970 million people worldwide were living with a mental health disorder, according to WHO.

Examples of mental health disorder include depression, anxiety disorders, schizophrenia, bipolar disorder, eating disorders, and addictive behaviors.

Mental health disorder or mental illness as a medical condition becomes a cause of lean addiction because the affected individuals may start using a specific substance, in this case lean, to cope with the symptoms they’re experiencing. Lean drink produces pleasurable effects that make people feel good and allow them to handle intense symptoms of their mental illness. Unfortunately, research about the connection between mental illness and lean addiction is lacking, but National Institute on Drug Abuse explained mental illness and substance use have similar risk factors such as genetics and stress. They also suggested that when a person develops a mental illness, related changes in the brain activity may enhance the vulnerability to problematic use of substances by increasing their rewarding effects, decreasing awareness of their negative effects, or relieving unpleasant symptoms or side effects of medications.

4. Underlying medical conditions

Underlying medical conditions are chronic diseases that interfere with daily life or activities and require continuous medical attention or medical care that lasts longer than one year.

Examples of underlying medical conditions include heart disease, obesity, diabetes, high blood pressure, lung disease, kidney disease, or cancer. 

Underlying medical conditions become a cause of lean addiction because they have a negative impact on mental health. P.A. Herrera et al. report in their paper from the November 2021 issue of the International Journal of Environmental Research and Public Health that chronic illness can negatively affect mental health and cause problems such as depression because the burden of suffering from chronic disease negatively affects the quality of life. Chronic illness may also negatively affect the self-esteem and mood of an affected individual. More precisely, a patient with chronic illness is more susceptible to mental disorders, which is why a person may use substances such as lean to cope.

5. Co-occurring substance use

Co-occurring substance use is when a person uses two or more substances such as drugs and alcohol. They may even develop an addiction to both substances.

An example of co-occurring substance use is the consumption of alcohol in addition to lean, or smoking cigarettes and drinking, and taking other drugs such as cocaine, heroin, or marijuana in addition to lean drink.

Co-occurring substance use becomes a cause of lean addiction because it may provide synergistic effects of both drugs. People tend to use one drug as a primary drug and the other substance as an additional drug to compensate for side effects, or tolerance, or to make their experience more enjoyable.

How does lean addiction impact mental health?

Lean addiction impacts mental health through direct influence on the brain, which leads to mental and physical dependence. Lean contains codeine, which is habit-forming. Lean can also change the perception of reality and cause hallucinations. In fact, a French study by L. Garcin et al. from the November 2016 issue of Archives de Pediatrie found that a teenager who used lean experienced hallucinations in addition to effects such as drowsiness. Promethazine can also cause problems such as hallucinations, as per a paper that F. Schifano et al. published in the May 2021 issue of Frontiers in Psychiatry. 

One of the older studies, published in the August 1999 issue of the Journal of Clinical Psychopharmacology, focused on codeine and confirmed it is associated with depressive symptoms. Since codeine is mainly used for making lean drink, addiction to this concoction could lead to mood problems and further affect mental health. Lean can act on brain chemistry and impair a person’s mental health in the process.

What are the symptoms of lean addiction?

The symptoms of lean addiction are listed below:

• Increased tolerance
• Relationship problems
• Health problems
• Financial difficulties
• Compulsive drug-seeking behavior
• Loss of control
• Withdrawal symptoms
• Physical and psychological dependence
• Neglecting responsibilities
• Changes in behavior and mood

1. Increased tolerance

Increased tolerance occurs when the body gets used to a substance (medication, alcohol, illicit drugs) so a higher dosage is necessary to achieve the desired effects. Tolerance is a diminished response to a substance due to prolonged and repeated use.

Increased tolerance becomes a symptom of lean addiction because excessive intake of the concoction changes how the body and brain react to it. They become less sensitive to the effects of the drug, which means the current intake is not enough to achieve the pleasurable effects. To overcome that problem, people increase their intake of a substance (in this case lean drink), which further worsens addiction and its consequences. 

While there are no studies regarding tolerance to lean, a paper titled “Opioid Tolerance Development: A Pharmacokinetic/Pharmacodynamic Perspective” from the December 2008 issue of The AAPS Journal provides a useful insight into this subject because codeine is an opioid too. As per the paper, tolerance to opioids occurs through three mechanisms: pharmacokinetic, pharmacodynamic, and learned. Pharmacokinetic tolerance results from altered drug metabolism as a function of time, whereas pharmacodynamic tolerance occurs upon diminished intrinsic responsivity of the receptor system over time. Learned tolerance can be behavioral or conditional. This type of tolerance happens when a person learns to function despite repeated exposure to the substance.

2. Relationship problems

Relationship problems are arguments and disagreements within close relationships. These problems are usually discussed in terms of love partners experiencing difficulties, but they can affect any kind of relationship, including friendship or family dynamics. Relationship problems are a normal part of dealing with differences in ideas, beliefs, and perspectives, but it is not considered normal when they are constant, according to the Australian Psychological Society.

Relationship problems become a symptom of lean addiction because it becomes difficult to maintain trust, respect, and open communication with an addicted individual. A person with lean addiction may deny they have a problem even after their loved ones express concerns. They may promise to change their behavior but use substances such as lean in secret, which further worsens their relationship with their partner or family members. Additionally, a person with lean addiction may spend an increasing amount of time using lean or trying to obtain (or make it), which means they spend less time with a loved one. This enhances the distance between people, and it becomes difficult to overcome problems that addiction keeps amplifying. 

3. Health problems

Health problems are diseases or medical ailments i.e., changes in a person’s health or physiological condition due to illness or injury. They can be acute or short-term and chronic or long-term. Health problems range from mild to severe and life-threatening. 

Health problems become a symptom of lean addiction because this concoction contains an opioid that has a negative effect on the brain and body. For example, lean can slow heart rate and breathing. Lean exhibits an opioid-like effect on the heart and lungs, thereby depriving the body and brain of oxygen. For that reason, a person addicted to lean may experience seizures.

Since the lean drink is abundant in sugar, addiction can lead to tooth decay due to repeated use. Besides, high sugar content, lean addiction causes tooth decay because opioids such as codeine cause dry mouth, thereby creating fertile ground for bacteria. In their review from the March 2022 issue of Polymers, A. Kapourani et al. confirmed the most common cause of xerostomia (dry mouth) is medications and also identified opioids such as codeine and morphine as drugs that lead to this problem. Codeine is a morphine derivative. Even in small amounts, opioids like codeine can impair a person’s vision. 

When it comes to health problems, people with lean addiction may develop digestive problems because opioids like codeine slow the body’s systems. The opioid molecules in codeine bind and activate receptors in the gastrointestinal (GI) tract, thereby making it difficult to empty the bowel due to the hardening of feces. Food takes longer to pass through the GI system, according to Healthline. Digestive health is important for overall health and well-being, which is why irregular bowel movements can cause stress, appetite changes, skin problems, and even hemorrhoids. Moreover, lean addiction could manifest itself through other health problems such as liver damage due to acetaminophen. 

4. Financial difficulties

Financial difficulties are situations when a person is not able to pay their bills on time or afford necessary, basic needs. People deal with financial difficulties due to multiple factors ranging from unemployment to high-interest rates and irresponsible spending. Addiction is also the reason for financial distress.

Financial difficulties become a symptom of lean addiction because an addicted individual spends a lot of money to keep using the concoction. In addition to spending too much money on obtaining or making lean drinks, a person with addiction may struggle at work which reflects in their earnings as well. People with addiction tend to experience health problems (described above) or they get into legal troubles, all of which come with hefty costs and further worsen the financial situation.

5. Compulsive drug-seeking behavior

Compulsive drug-seeking behavior is a term that refers to activities directed toward the attainment of sought-after drugs. People may falsely report symptoms in order to obtain a prescription for medication or request a drug in order to maintain their drug addiction. Drug-seeking behavior also involves changing doctors or forging signatures just to obtain a specific medication, such as codeine.

Compulsive drug-seeking behavior comes as a symptom of lean addiction because people need a prescription for codeine, which they need to make this concoction. Drug addiction itself is a compulsive need to use a substance despite negative consequences. A person with lean addiction experiences a strong urge to use the concoction, but the only way to make it happen is to obtain it from people who make it or to prepare it on their own. Codeine prescription is necessary for this purpose, which is why drug-seeking behavior becomes more intense. A patient may describe symptoms that significantly deviate from objective evidence or the physical examination findings. They may insist on receiving a controlled drug prescription on the first visit and claim that OTC medications don’t work or that they are allergic to them. Also, patients tend to claim they have a high tolerance to the drug and may lose prescriptions or run out of them early, according to a paper by L.P. Longo et al. in the April 2020 issue of the American Family Physician. Compulsive drug-seeking behavior worsens with the increased severity of a person’s addiction. 

6. Loss of control

Loss of control is defined as being unable to regulate or handle behaviors and impulses that occur due to emotional distress, as per Chapter 204 Loss of Control in Clinical Methods: The History, Physical, and Laboratory Examinations, 3^rd Edition from 1990. People lose control due to many reasons, such as anger, fear, stress, and grief. Addiction is also one of the culprits for loss of control. 

Loss of control becomes a symptom of lean addiction because of the concoction of how a person thinks and behaves. According to a review that M. Lyvers from Bond University in Queensland, Australia published in the May 2000 issue of the Experimental and Clinical Psychopharmacology, impairments to the frontal lobe due to long-term substance abuse may lead to compulsive behavior, which is the behavior that a person can’t control. A person with lean addiction, or any other type of addiction, can’t determine or predict how much of the substance they intend to use or for how long they are going to use it.

7. Withdrawal symptoms

Withdrawal symptoms are a part of the withdrawal syndrome, which is the process of cutting out addictive substances such as lean. The symptoms of withdrawal vary from mild to severe, depending on how serious a person’s addiction is. The most common symptoms of lean withdrawal include agitation, loss of appetite, teary eyes, runny nose, body aches, trouble sleeping, and diarrhea. Other withdrawal symptoms include irritability, nausea and/or vomiting, and stomach cramps.

Withdrawal symptoms become a symptom of lean addiction because the brain and body get used to the presence of a concoction that they start reacting through withdrawal syndrome when a person stops using the substance. While there is no research on lean addiction and withdrawal symptoms specifically, a paper by M.E. Piper from the December 2015 issue of Nicotine and Tobacco Research provided a useful insight into withdrawal from substance abuse. The classical theory, as per the paper, is that withdrawal symptoms are produced by the development of dependence and discontinuation of substance use. At the same time, withdrawal symptoms motivate a person to keep using the substance. What’s more, withdrawal is a major factor in determining whether an agent is addictive. Codeine carries a risk for abuse and addiction, as previously stated. The elicitation of withdrawal results from internal cues such as falling substance levels, but environmental elicitation is also involved. That means the cue reactivity could play a role as well. For example, a person is in a setting where they consume lean and that specific environment could trigger withdrawal symptoms. Withdrawal in addicted individuals also occurs through the activation of neurobiological pathways.

8. Physical and psychological dependence

Physical and psychological dependence is the way a specific substance affects the body and brain (emotional and mental health and well-being). Physical dependence involves tolerance and withdrawal symptoms, which are clear signs that a person has become addicted to the substance such as lean concoction. Psychological dependence is the compulsion of the mind to use a substance based on the perceived need the substance fills.

Physical and psychological dependence becomes a symptom of lean addiction because this concoction contains medication with addictive properties. As an opioid, codeine activates powerful reward centers in the brain and triggers the release of endorphins or feel-good chemicals. With repeated use, a person believes they need a drug for survival or to feel good again. However, constant exposure to a specific substance can reduce the sensitivity of dopamine receptors, which motivates a person to keep using more. When they stop using the concoction, they may develop withdrawal symptoms (described above), which are the physical aspect of dependence and they start craving lean drinks or have a compulsive need to keep using it, which is a psychological aspect of dependence.

A post, last updated in April 2023, by M. Azadfard et al. on the website of the National Library of Medicine suggested that opioids bind to receptors in the central and peripheral nervous systems with treatment effects for cough or pain, but action on these receptors can produce euphoria. As a result, a person may want to continue using the substance to recreate the high effect. They become addicted, which includes both physical and psychological dependence.

9. Neglecting responsibilities

Neglecting responsibilities refers to failing to perform duties associated with employment, failing to complete a specific task, or not fulfilling commitments or chores in everyday life. People neglect responsibilities for many reasons ranging from being stressed out and overwhelmed to being irresponsible, having a physical or mental illness, and having an addiction.

Neglecting responsibilities becomes a symptom of lean addiction because the addictive substance changes the balance of chemicals in the brain. When that happens, a person thinks, perceives, and behaves in ways that are different from before when they didn’t have lean addiction. To a person with addiction, achieving the desired effect is the main goal in life. They spend a lot of time thinking about the substance, using it, or planning how to obtain it. Since the addictive substance becomes the center of attention in a person’s life, everything else is pushed back. That’s why they fail to do household chores or keep up with their promises. Their productivity at work becomes weaker; they miss or skip appointments, or fail to meet deadlines. In addition to being preoccupied with the substance, they neglect responsibilities due to the effects of lean drinks.

10. Changes in behavior and mood

Changes in behavior and mood are abrupt shifts in an emotional and mental state of an individual. They can be a normal response to situations such as hormonal imbalances or stress. Mental health illnesses can also cause mood and behavioral changes. A good example is bipolar disorder. However, these changes can also occur as a consequence of a substance use disorder.

Changes in behavior and mood become a symptom of lean addiction because the substance causes neurological changes and psychological dependence. Opioid abuse is associated with changes in mood and may contribute to mental disorders reported Johns Hopkins in December 2011. These changes stem from the effect of the substance on brain chemicals. Also, addictive substances cause a loss of impulse control, which means a person behaves in a way they usually would not. People with lean addiction also change behavior as they become more secretive in order to hide their substance abuse. Neglecting responsibilities and fighting with family or loved ones are also behavioral changes. As the levels of the substance fluctuate so do the neurotransmitters in the brain, which reflects mood changes. For that reason, a person’s mood goes from peaceful and happy to irritable and agitated. 

Behavioral changes in lean addiction may also manifest themselves through anger or aggressiveness, sleeping more than usual, losing interest in activities once enjoyed, dropping old friends, and starting hanging out with new friends. The new friends are from the same social circle i.e. they may also consume lean drinks.

When do lean addiction symptoms usually occur?

Lean addiction symptoms usually occur within a couple of weeks upon regular use. While information specifically focused on lean is lacking, Johns Hopkins Medicine reports that symptoms of opioid use disorder develop within several weeks of use but the exact timeframe varies from person to person. Even the first dose can have physiological effects that make a person vulnerable or susceptible to addiction. Mayo Clinic reports that even short-term use can cause addiction.

The onset of effects of lean is also useful to mention; they tend to occur within 30 to 45 minutes. The UK’s NHS reports that codeine in all forms may take 30 to 60 minutes to work but the effects stop after a few hours.

Higher amounts of codeine in the concoction (sometimes even 25 times higher than the recommended dose) shorten the onset of effects and make them appear sooner. The peak effects of lean occur one to two hours after ingestion. The total duration of lean effects is four to six hours. Codeine, the main ingredient in the lean drink, can stay in the system for up to 48 hours after the last use. The presence of codeine can be detected in saliva for one to two days after the last use, up to 24 to 48 hours in the blood as per a paper by A.G. Verstraete in the April 2004 issue of Therapeutic Drug Monitoring, two to four days in urine according to a paper by K.E. Moeller et al. in the May 2017 issue of Mayo Clinic Proceedings, and two to three months in hair according to a study by D.E. Rollins et a. in the May 1996 issue of the European Journal of Clinical Pharmacology.

What are the risk factors for lean addiction?

Risk factors for lean addiction are listed below:

• Age: even though people of all ages may use lean, it is most popular among adolescents and young adults. A combination of ingredients produces a tasty concoction that is appealing to younger people.
• Lifestyle: lean or purple drank has been associated with the music scene since it originated in Houston. It is particularly linked with the hip-hop scene and even with EDM. A person with a party lifestyle may be more exposed to the drink and thereby has a higher susceptibility to developing an addiction to it. People use lean drink at parties to have more fun.
• Personal history of substance abuse: a person is more likely to develop lean addiction if they were addicted to a different substance, such as alcohol or drugs, or they still misuse it.
• Family history of substance abuse: according to the National Institute on Drug Abuse, about half of a person’s risk of being addicted to a specific substance depends on their genetic makeup. Substance use disorders have a genetic component. For that reason, a family history of SUD increases the risk of developing lean addiction. 
• Peer influence: since lean drink is usually consumed by adolescents and young adults, they may start consuming the concoction due to peer influence. This could lead to developing an addiction. In their study from the December 2019 issue of BMC Public Health, W. Akande-Sholabi et al. reported that peer influence and experience of side effects are predictors of codeine misuse. 
• Poor mental health: individuals with mental health problems, such as depressive symptoms are more susceptible to using lean drink and becoming addicted to it.
• Lower socioeconomic class: persons with lower socioeconomic status are more prone to using lean, according to the paper in BMJ Case Reports. That means they are also more likely to develop an addiction to this substance. Poverty and unemployment are identified as risk factors for opioid addiction by Mayo Clinic as well.
• Stress: lean produces relaxing and stress-relieving properties, which is why a person may use it to deal with stressful circumstances. Stress is also identified as a risk factor for opioid addiction in general by Mayo Clinic.
• Risk-taking behavior: risk takers are more likely to engage in potentially dangerous situations, which also include using substances and becoming addicted to them.

How is lean addiction diagnosed?

Lean addiction is diagnosed upon a thorough evaluation. There is no specific protocol or a single test for the diagnosis of lean addiction only. The process of detecting and diagnosing substance use disorders generally follows the route of evaluating a patient’s medical history and behaviors. The doctor may order drug tests to determine the presence of substances in a patient’s system and evaluate prescription drug monitoring program reports. 

Since lean addiction itself is not in DSM-5, it’s important to mention the diagnostic criteria for opioid use disorder because codeine is an opioid. In order to confirm the diagnosis of OUD, a patient should meet at least two of 11 symptoms within a 12-month period. These include taking opioids in larger amounts or over a longer period than intended, persistent desire or unsuccessful efforts to stop using the substance, spending a lot of time on obtaining the substance/using it/recovering from its effects, and experiencing cravings. Other diagnostic criteria include neglecting responsibilities at work/school/home, continuing using the substance despite interpersonal problems, giving up social or occupational activities in favor of substance abuse, recurrent use in situations when it’s unsafe, continuing using the drug regardless of physical health effects and dangers, and experiencing tolerance and withdrawal. 

Upon diagnosis of addiction, a healthcare professional proceeds to determine the severity. Generally speaking, the presence of two to three criteria for OUD is considered mild addiction. Four to five signs indicate moderate addiction. Six or more signs represent severe addiction, according to Cleveland Clinic.

Where can you seek lean addiction diagnosis?

You can seek lean addiction diagnosis in facilities with psychiatrists, psychologists, or addiction counselors who have experience with patients affected by different forms of SUDs including lean addiction. Places where a person can seek lean addiction diagnosis are listed below:

• Addiction treatment centers (rehab facilities)
• Hospitals 
• Clinics
• Local non-profit organizations with addiction treatment programs

What are the treatments available for lean addiction?

The treatments available for lean addiction are listed below:

• Detoxification: the first stage of the addiction treatment process; the abrupt cessation of substance use. During detox, patients tend to experience withdrawal symptoms. Detoxification helps to treat lean addiction because it eliminates the presence of the addictive substance and minimizes physical harm caused by the abuse of the drug. It is performed under medical supervision so a patient gets much-needed support on the road to recovery. Lean withdrawal isn’t life-threatening, but the process of detox may be uncomfortable due to the aforementioned withdrawal symptoms. To make the process easier, a patient may receive medications that alleviate the severity of symptoms they’re experiencing. The length of the process depends on the severity of the addiction, but it is typically three to 10 days long. Detoxification is effective in the treatment of addiction, but it is not a standalone treatment. Instead, it should serve as an entry point to addiction treatment as per a paper by C. Timko et al. in the November 2016 issue of the Journal of Substance Abuse Treatment.

• Inpatient treatment: a type of program that requires a patient with lean addiction, or SUDs in general, to live in a rehab facility where they receive around-the-clock care. This type of treatment approach is most suitable for people with moderate to severe addiction. Inpatient program helps to treat lean addiction because patients live in a structured environment where they attend therapy sessions and learn skills necessary for recovery and a sober lifestyle. During therapy sessions such as cognitive-behavioral therapy (CBT), patients with lean addiction learn to identify negative or irrational thoughts that influence their emotions and behaviors that lead to addiction. Once they identify negative thinking patterns, they work closely with a therapist to change them. Therapy sessions can be individual or group therapy, all of which are helpful to patients with addiction. The length of inpatient treatment can be 30, 60, or 90 days depending on the severity of addiction and the patient’s individual needs. Inpatient treatment is effective for the treatment of substance use disorders because it may lessen substance misuse and reduce cravings, as per a report “Residential Treatment for Substance Use Disorder: a Review of Clinical Effectiveness” published by the Canadian Agency for Drugs and Technologies in Health in January 2019.

• Outpatient treatment: a type of program that provides care and support to patients with addiction, but doesn’t require them to live in the rehab facility. This type of treatment program is ideal for persons with mild to moderate addiction. Outpatient treatment helps to treat lean addiction by providing support and therapy sessions or education to patients with addiction, but they can return to their home or sober living facility afterward. It gives people more structure and continued support in real-life or daily circumstances when they are more likely to be exposed to the triggers that cause their addiction. Patients receive therapy for two to eight hours a day several times a week, usually for two to five days. The length of outpatient treatment is usually eight to 12 weeks depending on the patient’s needs and the severity of their addiction. Outpatient treatment is effective and according to a study by D. McCarty et al. in the June 2014 issue of Psychiatric Services, these programs are just as effective as inpatient programs. What’s more, outpatient treatment programs are important for a continuum of care.

• Support groups: gatherings of people facing common issues to share their troubles. Support groups involve meetings in places such as community centers, but they can also take place online. They help to treat lean addiction because patients get to connect with people who are in the same situation. Members of support groups share their experiences and talk about the challenges of recovery or maintaining sobriety. Their stories serve to encourage and motivate fellow members. There is no specific length of support groups, people can attend meetings for as long as they think they need it. Patients who recover from addiction tend to go to meetings regularly for years after getting “clean” and sponsor the new group members. Support groups serve as long-term support to one’s recovery. Support groups are effective in the treatment of addiction and reducing cravings, but more research on this subject is necessary as per a paper “Benefits of Peer Support Groups in the Treatment of Addiction” from the September 2016 issue of Substance Abuse and Rehabilitation.

When should we seek treatment for lean addiction?

Treatment for lean addiction is best sought as soon as a person starts exhibiting signs of this type of substance use disorder. A person with lean addiction may refuse to acknowledge they have a problem and seek professional help on their own. A strong support system is necessary because family and friends can encourage them to get help. Education about lean addiction is important; the more a person is informed, the more confident they’re going to be in the decision to seek treatment whether on their own terms or by being encouraged by their loved ones. Common signs that say it’s time to seek treatment for lean addiction include social withdrawal, loss of interest, spending time in social circles known for the use of addictive substances such as lean, failing to keep up with responsibilities, cravings for the substance, lying or stealing money to obtain lean, changes in appearance or habits.

How long does lean addiction recovery typically take?

Lean addiction recovery typically takes several weeks or months. The specific timeframe during which it takes to recover doesn’t exist. Factors such as the frequency of using lean, how much a person drinks, and the presence of mental health problems or co-occurring addiction can influence the duration of recovery. Detox itself can last up to 10 days, but symptoms of withdrawal peak within two to three days after cessation of substance use.

What are the alternative therapies for lean addiction?

The alternative therapies for lean addiction include holistic approaches such as hypnosis, acupuncture, acupressure, eye movement desensitization and reprocessing (EMDR), and herbalism. These approaches are beneficial for teens and young adults with a co-occurring disorder and those who respond well to music, dance, art, and exercise. Mind-body therapies such as acupuncture, or particularly meditation, could help with substance use disorder recovery but more research on this subject is necessary. According to a paper by J. Junyue et al. in the Frontiers in Psychiatry in 2021, complementary and alternative medicine practices could decrease relapse and substance-related injuries.

How is lean addiction prevented?

Lean addiction is prevented by raising awareness of lean concoction and its dangers as well as informing high-risk groups about the dangerous effects of codeine. An important prevention strategy is to avoid people and places known for lean use. Parents of adolescents may want to monitor their child’s online activity to ensure they’re not looking for online recipes to make lean drink. They also need to monitor a child’s medication use or keep an eye on their medicine if the parent is the one who is prescribed codeine-containing syrup. Parents should encourage open communication with their children. Adolescents and young adults should be encouraged to choose their social circle wisely and to understand that using drugs such as lean isn’t the right way to have fun or get colleagues and peers to like them. Saying no to the drink when offered is always the smartest choice.

Can providing stress management reduce the risk of addiction?

Yes, stress management can reduce the risk of addiction because stress is a risk factor for developing substance use disorders. To understand why that happens it’s important to know what stress is; a normal reaction to negative situations or stimuli, but it becomes a problem when left unmanaged. People may start using drugs such as lean concoctions to deal with stress. Indeed, the lean drink exhibits stress-relieving properties and promotes relaxation. Stress increases sensitivity to cravings for drugs, according to a paper by R. Sinha in the October 2008 issue of the Annals of the New York Academy of Sciences. For that reason, managing stress could reduce the need and cravings for addictive substances.