Mixing cocaine and alcohol is more dangerous than using either drug alone. When both are in your body, your liver makes a new substance called cocaethylene. It lasts longer than cocaine and puts extra strain on your heart and liver.

The combination raises the risk of heart attack, stroke, seizures and sudden death, even in young, healthy people. If someone has chest pain, trouble breathing or a seizure, or won’t wake up, call 911.

Need help with cocaine or alcohol use? Call (407) 680-1226 or verify your insurance to talk about treatment in Orlando.

What is cocaethylene?

Cocaethylene forms in the liver when cocaine and alcohol are in your system at the same time. Normally, the liver breaks cocaine down into inactive substances that leave the body. When alcohol is present, a liver enzyme combines the two and makes cocaethylene, which acts on the brain much like cocaine does.

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Cocaethylene matters for three reasons:

  • It lasts longer. Cocaethylene stays in the body several times longer than cocaine, so its effects on the heart continue after the cocaine high fades.
  • It can raise cocaine levels. Drinking can also increase how much cocaine ends up in your blood.
  • It’s harder on the heart. Research suggests cocaethylene is more toxic to the heart than cocaine alone.

How does mixing cocaine and alcohol affect your heart and liver?

Heart and blood vessels

Cocaine speeds up your heart, raises your blood pressure and narrows blood vessels, including the arteries that supply the heart. Cocaethylene adds to these effects and makes them last longer. Risks include:

  • chest pain and heart attack, even in young people without heart disease;
  • dangerous heart rhythm problems (arrhythmias);
  • weakening of the heart muscle (cardiomyopathy) with repeated use;
  • stroke and bleeding in the brain;
  • sudden death.

Liver

Your liver has to process alcohol, cocaine and cocaethylene at the same time. Alcohol already damages the liver over time, and cocaine and cocaethylene can add to that injury. Regular use of both may raise the risk of serious liver damage.

Brain, mood and behavior

The combination can cause seizures, anxiety, paranoia and impulsive or aggressive behavior. Using both is linked to more accidents, violence, drunk driving and unsafe sex. It’s also linked to higher rates of depression and suicidal thoughts. If you or someone you know is thinking about suicide, call or text 988.

What are the signs of a cocaine and alcohol overdose?

Cocaine can make you feel less drunk than you are, so it’s easy to drink more than you realize. When the cocaine wears off, the full effect of the alcohol can hit at once. Each drug can also hide the warning signs of the other.

Call 911 right away if someone has:

  • chest pain or pressure;
  • a very fast, pounding or irregular heartbeat;
  • trouble breathing, or slow or irregular breathing;
  • a very high body temperature, heavy sweating or hot, dry skin;
  • severe agitation, panic, paranoia or confusion;
  • a seizure;
  • sudden weakness or numbness on one side, trouble speaking or a sudden, severe headache;
  • vomiting while confused or drowsy;
  • blue or gray lips or fingertips, or they can’t be woken up.

Stay with the person until help arrives. If they’re vomiting or unconscious, turn them onto their side. Street cocaine is sometimes mixed with fentanyl, so if the person is breathing slowly or not at all, give naloxone (Narcan) if you have it. Naloxone won’t harm someone who hasn’t taken opioids.

Florida’s 911 Good Samaritan law protects people who call for help during an overdose from some drug possession charges, so don’t let fear of arrest stop you from calling.

Why do people mix cocaine and alcohol?

Many people who use cocaine also drink, often at parties, bars or clubs. Common reasons include:

  • A longer, stronger high. Cocaethylene can make the euphoria feel more intense and last longer.
  • Drinking more without feeling as drunk. Cocaine’s stimulant effect masks some of alcohol’s sleepiness.
  • Easing the comedown. Some people drink to take the edge off the anxiety, irritability and restlessness that come as cocaine wears off.

These same effects are what make the combination risky. It’s easier to lose track of how much you’ve used, and using the two together may make dependence on either drug develop faster.

Getting help for cocaine and alcohol addiction at Orlando Recovery Center

Recovery can be harder when you’re using two substances, often along with stress, anxiety or depression. Good treatment addresses all of it.

At Orlando Recovery Center, adults 18 and older can receive:

  • Medical detox with medical supervision and medications to manage withdrawal symptoms when medically appropriate. Most patients complete detox in six to nine days.
  • Residential treatment with individual and group therapy, typically for 14 to 21 days.
  • Partial hospitalization (PHP), which offers full days of treatment without an overnight stay, typically for 14 to 21 days.
  • Mental health care for co-occurring conditions such as depression and anxiety.
  • Aftercare planning, so you leave with a plan and support in place.

These lengths of stay are typical. Yours is based on your clinical needs and your insurance. If you step down to intensive outpatient care (IOP), it’s offered at our sister facility, Orlando Outpatient Center in Maitland.

What withdrawal from cocaine and alcohol can feel like

Cocaine withdrawal is mostly a “crash”: exhaustion, low mood, irritability, strong cravings and either trouble sleeping or sleeping much more than usual. Alcohol withdrawal is different. After heavy, regular drinking, it can cause shaking, sweating, anxiety, seizures and delirium tremens (DTs), which can be life-threatening. That’s why stopping heavy drinking should happen under medical care.

Read more about the cocaine withdrawal timeline.

Does insurance cover treatment?

We’re in network with several insurers for substance use treatment, including Aetna, Cigna, Florida Blue (BCBS), Humana and UnitedHealthcare/Optum. Coverage depends on your plan, so verify your insurance or call (407) 680-1226.

Cocaine and alcohol FAQs

What is cocaine washout syndrome?

Cocaine washout syndrome is a period of extreme exhaustion and deep, prolonged sleep that can follow a heavy cocaine binge. The person may be very hard to wake, but it usually improves within one to a few days. Because it can look like an overdose, alcohol poisoning, a stroke or a head injury, anyone who can’t be woken normally needs emergency care. Call 911.

Which drugs shouldn’t be mixed with alcohol?

Many drugs are dangerous with alcohol. Some of the most serious combinations are:

  • Stimulants such as cocaine, meth and ADHD medicines, which can hide how drunk you are and strain the heart;
  • Opioids such as Percocet, oxycodone, hydrocodone, heroin and fentanyl, which can stop your breathing;
  • Benzodiazepines such as Xanax, Klonopin and Valium, which also slow breathing;
  • Sleep medicines, muscle relaxants and gabapentin, which add to sedation;
  • Acetaminophen (Tylenol), which raises the risk of liver damage, especially in large amounts.

Many prescription and over-the-counter medicines carry alcohol warnings. Ask your pharmacist before drinking while you take any medication.

Is it safer to drink to come down from cocaine?

No. Drinking while cocaine is still in your system creates cocaethylene and adds to the strain on your heart. It can also lead you to drink far more than you realize.