Alcohol & Health
Treatment
Helping Alcoholics
Medically Reviewed by Dr P. E. Pancoast, MD
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When partying, people can make bad decisions, sometimes involving drug use. Usually, this consists in having one-too-many drinks and waking up the following day with a nasty hangover. But sometimes, it involves other drugs, such as cocaine.
People sometimes take both alcohol and cocaine together, thinking they can counteract each other’s negative effects. Because alcohol is a depressant and cocaine is a stimulant, the idea is they can “balance” each other out.
While it might sound good in theory, this is a dangerous myth.
Mixing both cocaine and alcohol leads to the production of cocaethylene, a highly toxic substance. Cocaethylene toxicity is higher than either drug alone and can lead to substance use disorder and serious health risks.
Alcohol is a central nervous system (CNS) depressant. That means it slows down the activity in your brain and CNS.
Alcohol consumption affects the brain in a variety of ways.
These include:
With increased alcohol consumption, these effects grow in intensity, leading to alcohol poisoning. Effects here include reduced body temperature, memory impairment, vomiting, slowed heart rate, and, ultimately, death. Additionally, it's already hard for some to know when they have drunk too much.
Alcohol is also known to interact with a variety of other substances, amplifying their effects. One of the most common alcohol interactions is alcohol and cocaine.
Cocaine is a highly addictive stimulant that has been used in the United States since the late 19th century. Stimulants speed up the activity in your brain and CNS.
Cocaine comes in several forms. The most common is a fine white powder. There is also a fat-soluble, solid form known as “freebase” cocaine, which is more potent.
Finally, there is a solid rock crystal made from mixing water and baking soda, known as crack cocaine.
Regardless of how it is consumed, a typical cocaine high has the following characteristics:
With increased cocaine intake, side effects can include increased body temperature and heart rate, convulsions, impaired breathing, and mood disorders. Long-time cocaine users can expect difficulty sleeping, liver damage, and cognitive issues due to brain atrophy.7
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When both cocaine and alcohol are taken together, your body produces cocaethylene. This substance enhances the euphoric effects of both drugs. Cocaethylene effects are also more intense and last longer than those from either alcohol or cocaine use alone.
Cocaethylene effects include high blood pressure, breathing issues, and tissue and organ damage. Sudden deaths have been known to occur due to heart attack and stroke.
One study found that those who drink alcohol after using cocaine have 20 to 30 percent higher blood cocaine levels.8 This leads to an increase in heart rate beyond that of the typical cocaine dose alone.
In other words, despite being a depressant, alcohol effectively increases the stimulant effects of cocaine.
Alcohol also increases cravings for cocaine, and this effect compounds as cocaine use increases.5
Cocaethylene increases the risk of impulsive behaviors such as violence and suicide.9
Mixing alcohol and cocaine leads to an 18 to 24 times higher chance of death compared to cocaine use alone.1
Your body usually metabolizes (processes) cocaine within roughly four hours, but various drug tests can detect it long after that period. Cocaine or its metabolites can be detected in the following ways:
On average, it takes about one hour for your body to metabolize one standard drink of alcohol. There are a handful of ways that alcohol can be detected in your system:
Cocaethylene can remain in your system for three to five times longer than cocaine.10
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When cocaine is consumed by itself, the liver is able to eliminate it relatively quickly. Concurrent ingestion of alcohol interferes with this process, slowing cocaine metabolism by 20 percent and producing cocaethylene.2
The liver usually begins cocaethylene production within two hours of alcohol and cocaine use. In turn, further alcohol consumption decreases cocaethylene metabolism by 20 percent.2
Cocaethylene toxicity is far higher than that of cocaine or alcohol. The toxic effects are more intense and longer-lasting. With concurrent alcohol consumption, peak cocaine blood levels are 20 to 30 percent higher.2 Blood alcohol levels are also increased from cocaethylene administration.2
As cocaethylene enters the bloodstream, it attaches to the same receptors in the brain seen in cocaine administration.2
Cocaethylene effects are more intense and longer lasting than those from alcohol or cocaine use alone. Also, the acute toxic effects from cocaethylene are stronger than from either cocaine or alcohol alone.
Cocaethylene is an active metabolite of cocaine and alcohol. An active metabolite is a modified form of the parent drug which continues to produce effects in the body. Cocaethylene toxicity is far greater than that of cocaine or alcohol use alone.
The half-life of a drug is the time required for your body to metabolize and eliminate half of the drug.
The half-life of cocaethylene is roughly two and a half hours. This is a three-to-five times longer elimination half-life than cocaine, but shorter than that of alcohol.10
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Cocaethylene formation leads to numerous health risks and complications.
These include:
When substance use involves at least two drugs or more, this is called polysubstance use. Withdrawal from multiple substances at the same time is an especially complex issue.
The first step is checking into an addiction treatment center for substance use. Here, substance use treatment professionals can monitor drug users 24 hours a day as they purge the toxic effects of cocaethylene from their systems.
After the initial detox and monitoring of the patient, addiction treatment can take place. The evidence here generally calls for a multi-pronged approach using both therapy and the latest medication.
Popular therapies for substance use include cognitive behavioral therapy (CBT), motivational enhancement therapy, and the popular “Twelve-Step” method. These therapies all seek to address the underlying causes of impulsive behaviors behind drug and alcohol dependence.
Inpatient and outpatient treatment programs are the most effective treatments for addiction.
Usually, these are tied to disorders such as depression, anxiety, ADHD, bipolar disorder, and schizophrenia.6
Medications used in conjunction with these therapies include disulfiram, naltrexone, topiramate, valproate, and baclofen.3 These medications are used to treat the cravings and withdrawal symptoms commonly associated with chronic drug use.
Cocaine or alcohol dependence alone are serious problems, but the two drugs combined create especially complex challenges.
Cocaine and alcohol use can lead to kidney, heart, and liver damage. Eventually, users may experience strokes or sudden heart attacks, leading to immediate death.
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