Mixing Cocaine & Alcohol: What to Expect

Man with substance abuse places cocaine and alcohol on the table

Cocaine mixed with alcohol is popular recreationally, with approximately 75% of cocaine users surveyed in the U.S. in 2018 reporting that they have used alcohol in conjunction with cocaine. People who co-use cocaine and alcohol do so for the prolonged euphoria and the ability to consume more alcohol than normal without experiencing the profound and debilitating effects of intoxication associated with binge drinking. Alcohol can also ease the discomfort associated with “coming down” from a cocaine high.

The combination of cocaine and alcohol leads to the production of an active metabolic byproduct called cocaethylene. Cocaethylene can be thought of as an exaggerated version of cocaine. It accumulates in the brain faster than cocaine, produces a more intense euphoria and because it has a longer half-life than cocaine, it stays in the brain for three to five times longer than cocaine. Although people who co-use cocaine and alcohol may enjoy the acute effects, the associated risks are high.

What Happens When Mixing Cocaine & Alcohol

When someone uses either cocaine or alcohol independently, their liver will hydrolyze the drug into metabolically inert chemicals that are excreted. When cocaine and alcohol are used together, the interaction that occurs in the liver produces a metabolically active byproduct called cocaethylene. Studies have shown that the cocaethylene half-life is between three and five times greater than the half-life of cocaine. This means that the physiological effects that occur after alcohol and cocaine co-use persist for up to five times longer than they would if someone had used only cocaine.

Cocaethylene, like cocaine, is able to cross the blood-brain barrier, meaning that it can pass from blood vessels into the brain to directly affect brain cells and accumulate in brain tissue. The physiological effects of cocaine and cocaethylene are similar, but cocaethylene accumulates up to four times more quickly than cocaine and has a half-life of between three and five times longer than the half-life of cocaine. In other words, the cocaethylene that is produced when alcohol and cocaine are used together causes physiological effects far more quickly than cocaine alone, and the duration of the effects is up to five times longer.

Side Effects

The cocaine-alcohol interaction that produces cocaethylene is associated with pleasurable physical and psychological effects, including:

  • High energy
  • Perception of mental alertness
  • Euphoria
  • Self-confidence
  • Decreased social anxiety

However, cocaethylene side effects can also be negative and may be associated with dangerous and potentially fatal consequences, including:

  • Anxiety
  • Paranoia
  • Trembling
  • Elevated body temperature
  • Elevated heart rate
  • Cardiac emergencies: heart attack, arrhythmia, cardiomyopathy
  • Neurological emergencies: stroke, intracranial hemorrhage

Withdrawal

Both cocaine and alcohol are powerfully addictive drugs that can cause physical and psychological dependence after even a short period of regular use. Because cocaethylene acts more quickly and with stronger effects over a prolonged period than cocaine does, it can influence the neurochemical pathways that promote dependence and addiction far more strongly than alcohol or cocaine can when either one is used individually.

Withdrawal is a consequence of reducing or stopping the use of a drug that the brain has become dependent on. Physical and psychological symptoms associated with cocaethylene withdrawal include:

  • Anxiety
  • Irritability
  • Anhedonia (inability to experience pleasure)
  • Dysphoria (a general sense of unease or dissatisfaction)
  • Restlessness
  • Fatigue
  • Rapid mood swings
  • Trembling
  • Insomnia
  • Nausea/vomiting
  • Appetite changes
  • Cravings

Dangers of Cocaine & Alcohol

In spite of the short-lived pleasurable experiences that cocaine and alcohol co-use may cause, there are substantial risks of short- and long-term physical and psychological harm that far outweigh any upside of using these drugs together.

In addition to significantly increasing the risk of participating in dangerous behaviors like further drug use, unsafe sex and driving while intoxicated, several studies have shown that cocaine and alcohol co-use increases the risk of violence and accidental death. One recent study showed that the combination also increases the risk of suicide. Cocaethylene is also associated with more rapid development of cocaine and alcohol dependence and addiction.

A great deal of research is focused on cocaethylene toxicity, but all data currently available indicates that it is significantly more dangerous than either cocaine or alcohol. Physical dangers associated with cocaine and alcohol co-use include cardiotoxic events like heart attacks, arrhythmia and cardiomyopathy, even in otherwise healthy adults. Neurotoxic events may include cerebral hemorrhage (bleeding into the brain) or stroke. In addition, with regular cocaine and alcohol co-consumption, long-term structural damage occurs in parts of the brain that are responsible for behavioral regulation and appropriate decision making. Combining cocaine and alcohol also increases the risk of liver injury and immune system dysfunction.

Cocaine & Alcohol Overdose

The risk of overdose associated with the co-use of cocaine and alcohol is substantially increased compared to the overdose risk of either drug taken alone. This is due to the opposite physiological effects of each drug on the brain. Alcohol is a central nervous system (CNS) depressant, meaning that it slows activity in parts of the brain; cocaine is a CNS stimulant that increases activity in the same parts of the brain. Because of these opposing effects, they can mask the signs and symptoms of an overdose.

For example, if someone has taken a dangerous amount of cocaine, they will experience symptoms including difficulty breathing, racing heart rate, elevated body temperature and panic. The effects of alcohol are to slow breathing and heart rate, lower body temperature and reduce the risk of panic attacks. The masking effect of alcohol on a cocaine overdose will reduce the likelihood that someone will seek medical attention, and may even result in someone using more cocaine.

Cocaethylene production further increases the risk of overdose. Because cocaethylene has a longer duration of action in the brain than cocaine alone, when cocaine and alcohol are co-consumed over the course of an evening, the risk of overdose is substantially higher, especially if someone consumes large amounts of the two drugs rapidly. As the drugs are metabolized in the liver, the rapid production of cocaethylene and its sudden accumulation in the brain can quickly lead to a potentially fatal overdose.

Cocaine & Alcohol Addiction Treatment

Cocaine and alcohol use disorders are challenging to overcome, and when they are combined, recovery can be even more difficult. For most people, professional rehab is the safest and most effective strategy to achieve sobriety. Importantly, for someone who has developed a severe alcohol dependence, quitting “cold turkey” can be dangerous.

If you or someone you love struggles with cocaine or alcohol dependence, help is available. At The Orlando Recovery Center, our rehab professionals provide comprehensive care including medical detox, residential and outpatient programs, and ongoing aftercare to maximize your short- and long-term success in recovery. Contact us today to learn how professional rehab can help you or a loved one get your life back.

Sources:

Stewart, Julie. “What You Need to Know About Combining Cocaine and Alcohol.” Vice, November 5, 2018. Accessed October 8, 2019.

Jones, Alan Wayne. “Forensic Drug Profile: Cocaethylene.” Journal of Analytical Toxicology, February 2019. Accessed October 8, 2019.

Chapy, Hélène; et al. “Carrier-Mediated Cocaine Transport at the Blood-Brain Barrier as a Putative Mechanism in Addiction Liability.” International Journal of Neuropsychopharmacology, January 2015. Accessed October 8, 2019.

Arias, Sarah A.; et al. “Substance Use as a Mediator of the Association Between Demographics, Suicide Attempt History, and Future Suicide Attempts in Emergency Department Patients.” Crisis, September 2016. Accessed October 8, 2019.

Farooq, Muhammad U.; et al. “Neurotoxic and cardiotoxic effects of cocaine and ethanol.” Journal of Medical Toxicology, September 2009. Accessed October 8, 2019.

Kozor, Rebecca; et al. “Regular cocaine use is associated with increased systolic blood pressure, aortic stiffness and left ventricular mass in young otherwise healthy individuals.” PloS One, April 2014. Accessed October 8, 2019.

O’Neill, J; Cardenas, Valerie A; Meyerhoff, Dieter Johannes. “Separate and interactive effects of cocaine and alcohol dependence on brain structures and metabolites: Quantitative MRI and proton MR spectroscopic imaging.” Addiction Biology, September 2001.  Accessed October 8, 2019.