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Dangers of Mixing Cough Syrup and Alcohol

Teen girl hand pouring pink cough syrup from bottle to spoon  

When used as directed, cough syrup can effectively relieve cold symptoms. However, some of the ingredients in cough syrup are psychotropic at high doses. Teens abuse cough syrup recreationally to experience dissociative (feelings of detachment from self/reality) or hallucinogenic effects. Teenagers often call getting high off of cough syrup “robotripping.”

Cough syrup abuse can be dangerous even without alcohol. Combining cough syrup and alcohol increases the risk of overdose and other dangerous social and health consequences. Cough syrup and alcohol are both central nervous system depressants that can act together to cause respiratory depression (shallow, irregular breathing) that can lead to coma or even death.

What Is DXM?

Dextromethorphan (DXM) is a synthetic drug that is the active ingredient in many types of commonly abused cough syrups. When used inappropriately, DXM is a psychotropic drug. The DXM high often includes feelings of euphoria and visual and auditory hallucinations, but may also lead to panic attacks, paranoia, anxiety, and aggression. Teenagers who have consumed high doses of DXM can look like they are drunk on alcohol, often exhibiting slurred speech, poor motor control and they may experience nausea/vomiting.

Regular DXM abuse is associated with serious physical and psychological consequences, including tolerance, dependence and withdrawal. Cough syrup with DXM often includes other active ingredients that, when abused, can also have very serious health consequences. For example, the ingredient phenylephrine relieves sinus congestion, but an overdose can cause hypertension and seizures. The pain reliever acetaminophen can cause acute liver failure when taken at extremely high doses.

Cough syrups that include DXM, phenylephrine and acetaminophen are safe when taken as directed. However, cough syrup abuse can lead to dangerous, even fatal overdose. Teenagers are in a high risk demographic for cough syrup abuse, dependence and even addiction.

Common DXM Dosages

The typical adult dose for most DXM-containing cough syrup formulations is between 15-30 mg taken three to four times per day. At this dose, cough syrup is safe and is rarely associated with side effects.

Up to five “plateaus” of intoxication are reported for escalating DXM doses:

  • First Plateau (100+ mg): Mild stimulation and heightened perceptual awareness
  • Second Plateau (200+ mg): Euphoria and hallucinations
  • Third Plateau (300+ mg): Loss or motor coordination and distorted visual perception
  • Fourth Plateau (500+ mg): Sedation, feelings of dissociation from reality
  • Plateau Sigma (1000+ mg): Extreme hallucinations and dissociation; one report from someone who sought the plateau sigma level of high stated that “I had completely forgotten who I am and where I can be, and basically was [a] walking zombie experiencing death over and over as I am trying to make sense of the situation.”

Dangers of Mixing Alcohol and Cough Syrup

DXM and alcohol both depress activity in the central nervous system, which can cause dangerous respiratory depression, coma and death, even when taken individually at high doses. The risk of these dangerous effects are greatly increased when dextromethorphan and alcohol are combined because the drugs act synergistically; that is, they have a combined effect that is greater than would be expected based on the effects of the individual drugs. The risk of a DXM overdose is substantially increased when alcohol is also used.

Long-term DXM abuse is associated with very dangerous outcomes, including cognitive deterioration that is characterized by progressively worsening ability to manage responsibilities, mania, depression and even suicidal tendencies.

Among the potential adverse outcomes of combining alcohol with cough syrup are:

  • Respiratory depression
  • Brain damage
  • Irregular breathing
  • Dissociation or losing touch with reality
  • Seizures
  • Cognitive impairment
  • Permanent psychosis
  • Overdose

Teens Most Likely to Abuse Cough Syrup & Alcohol

Robotripping and “sizzurp,” “lean” or “purple drank” (cough syrup mixed with a soft drink, alcohol and hard candies like Jolly Ranchers that improve the taste) have become popular in hip hop subcultures because of rap artists like Chamillionaire and A$AP Rocky, who have made reference to using cough syrup to get high in their lyrics. Four-time Grammy Award winner Lil Wayne was hospitalized after overdosing on a prescription-strength cough syrup “sizzurp” drink, and cough syrup overdoses were involved in the deaths of popular rappers Pimp C and Big Moe.

These unfortunate instances and lyrical references put an alarming number of American youth at risk. Hip hop has become a mainstay of popular radio stations, which go to great lengths to ‘bleep’ cuss words but make no effort to obscure astonishingly lewd and dangerous references to drug use and other risky behavior. As a result, teenagers across America have the perception that robotripping and “sizzurp” are recreational activities that their favorite musicians regularly participate in.

Hip hop artists are not the only popular idols who participate in DXM and alcohol abuse. A number of NFL players including Rolando McClain, JaMarcus Russell, Terrence Kiel, and Johnny Jolly have all been arrested for illegal possession and abuse of prescription-strength cough syrup.

Signs of DXM and Alcohol Use

Signs of DXM and alcohol abuse include:

  • Signs of intoxication, including slurred speech and imbalance
  • Droopy eyelids
  • Uncontrolled eye movements
  • Constricted pupils
  • Erratic behavior
  • Constipation
  • Pale, clammy skin
  • Breathing trouble
  • Unusual desire or compulsion to take cough syrup
  • Unusual irresponsibility
  • Neglecting normal interests and hobbies

There are ways to limit your teenager’s access to DXM. If you keep cough syrup in your home, keep an eye on it to make sure it is not disappearing, and don’t purchase more than you need. If you notice that your teenager has cough syrup in his or her backpack, it may be worth checking in with them to make sure they are not abusing it.

Getting Help with Teen Addiction

Teenagers are at particular risk for lifelong damage as a consequence of substance use disorders. Alcohol use has very serious social and health consequences for adolescents and combining alcohol with other drugs, even ones that can be purchased over-the-counter, substantially increase the risk.

There are several Florida drug and alcohol treatment centers, but it is important to find one that is teen-specific and that can tailor their rehab programs to suit the needs of the individual participants. Next Generation Village in Sebring, Florida works with teenagers aged 13-17 and has proven that they can help teens achieve long-term success in recovery.

If you are concerned that your teen is abusing cough syrup, alcohol or any other substance, Next Generation Village can help. Our expert staff understands teen substance use disorders and our evidence-based rehab programs are designed to address the unique needs of teenagers. Call us today to learn more.

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