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Why Do People Mix Alcohol and Cocaine?

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. 

Effects of Alcohol

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:

  • Euphoria
  • Slurred speech
  • Reduced coordination or balance
  • Higher sociability, confidence, and aggression
  • Lower attention span
  • Slower reaction time

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.

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.

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Effects of 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. These three forms are consumed via nasal inhalation, injection, and smoking, respectively.

Regardless of how it is consumed, a typical cocaine high has the following characteristics:

  • Euphoria
  • Heightened sensitivity of touch and sound
  • Increased sociability, confidence, and aggression
  • Increased mental alertness

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 

Dangers of Mixing Alcohol and Cocaine

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 

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How Long Does Cocaine and Alcohol Stay in Your System?

Your body usually metabolizes (processes) cocaine within roughly four hours, but various drug tests can detect it long after that period. Cocaine can be detected in the following ways:

  • Blood — Up to 12 hours
  • Saliva — between two and nineteen hours 
  • Urine — around two to four days
  • Hair — up to 90 days

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:

  • Blood — Up to six hours
  • Breath — 12 to 24 hours
  • Saliva — 12 to 24 hours
  • Urine — 12 to 72 hours
  • Hair — Up to 90 days

Cocaethylene can remain in your system for three to five times longer than cocaine.10

What is Cocaethylene? How is it Produced?

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 The acute toxicity of cocaethylene is stronger than that from either cocaine or alcohol by themselves.2 

For this reason, cocaethylene effects are more intense and longer-lasting than those from alcohol or cocaine use alone. 

Is Cocaethylene an Active Metabolite?

Cocaethylene is an active metabolite of cocaine. 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 from cocaine or alcohol use alone.

What is the Half Life of Cocaethylene?

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 

How Does Cocaethylene Negatively Affect the Body?

Cocaethylene formation leads to numerous health risks and complications. These include:

  • Decreased motor function
  • Liver damage
  • Kidney failure
  • Reduced blood pressure
  • Increased heart rate
  • Higher blood pressure
  • Higher risk of stroke
  • Increased risk of violent behavior and suicide due to poor judgment
  • Heightened risk of anxiety, panic attacks, depression
  • Increased risk of cardiac arrest, including sudden heart attacks
  • Intracranial hemorrhage
  • Death

Treatment For Alcohol & Cocaine Intoxication 

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. 

Treatment for Alcohol & Cocaine Addiction 

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. 

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.

Resources

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Andrews, P. “Cocaethylene toxicity.Journal of addictive diseases, vol. 16, no. 3, p. 1997. pubmed.ncbi.nlm.nih.gov.

Dasgupta, Amitava. “Combined alcohol and drug abuse: A potentially deadly mix.Alcohol, Drugs, Genes and the Clinical Laboratory, pp. 75-88. www.sciencedirect.com.

Grassi, Maria Caterina, et al. “Short-term efficacy of Disulfiram or Naltrexone in reducing positive urinalysis for both cocaine and cocaethylene in cocaine abusers: a pilot study.Pharmacological research, vol. 55, no. 2, 2007, pp. 117-21. pubmed.ncbi.nlm.nih.gov.

Henning, R. J., and L. D. Wilson. “Cocaethylene is as cardiotoxic as cocaine but is less toxic than cocaine plus ethanol.Life sciences, vol. 59, no. 8, 1996, pp. 615-27. pubmed.ncbi.nlm.nih.gov.

Marks, Katherine M., et al. “Alcohol administration increases cocaine craving but not cocaine cue attentional bias.Alcoholism, clinical and experimental research, vol. 39, no. 9, 2015, pp. 1823-31. www.ncbi.nlm.nih.gov.

National Institute of Mental Health. “Substance Use and Co-Occurring Mental Disorders.www.nimh.nih.gov, 2021.

Pascual-Leone, A., et al. “Cerebral atrophy in habitual cocaine abusers: a planimetric CT study.Neurology, vol. 41, no. 1, 1991, pp. 34-8. Pubmed.ncbi.nlm.nih.gov.

Pennings, EJ M., et al. “Effects of concurrent use of alcohol and cocaine.Addiction, vol. 97, no. 7, 2002, pp. 773-83. Pubmed.ncbi.nlm.nih.gov.

ScienceDaily. “Simultaneous cocaine, alcohol use linked to suicide risk.www.sciencedaily.com, 2016.

T, Buddy. “How Long Does Alcohol Stay in Your System?” www.verywellmind.com, 2019.

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