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Mixing Cocaine and Alcohol

Cocaine is a highly addictive illegal drug that acts as a central nervous system (CNS) stimulant. In contrast, alcohol is a CNS depressant. Alcohol and cocaine counteract each other, which makes mixing the two substances a popular combination among users. 

People believe that mixing alcohol and cocaine helps balance the negative side effects of each substance. They also believe that alcohol helps prolong the “high” experienced with cocaine use. Unfortunately, while dangerous enough alone, these two substances can lead to serious medical complications and even death.

“The addition of alcohol to cocaine increases the risk of sudden death 25-fold.”

Medscape – Lynn Barkley Burnett, MD, EdD, LLB(c)

What is Cocaine?

Cocaine is a powerful and addictive stimulant derived from coca leaves. It has a long history, including its use in many elixirs in the 1900s. In addition, it was in the initial recipe for Coca-Cola. As time went on, researchers determined cocaine was actually highly addictive. It is now a Schedule II drug. 

Before the development of synthetic local anesthetics, surgeons used cocaine to block pain. However, its popularity is as a street drug known as Coke, Snow, Powder, or Blow. It is a fine, white powder or a solid rock crystal. Cocaine can either be injected, snorted, or smoked.


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Effects of Cocaine Use & Misuse

Cocaine is a fast-acting drug, often producing immediate effects. How quickly a person experiences effects and symptoms depends on how it is taken. This also affects the duration of symptoms. For example, snorting cocaine takes longer to produce effects, but they last longer. Smoking produces a quicker, but short-lived high.

The high a user experiences with cocaine occurs because it sends high levels of dopamine into the pleasure area of the brain. This increase in dopamine causes intense feelings of euphoria, energy, and mental alertness. Other short-term symptoms of cocaine use include:

  • Constricted blood vessels
  • Dilated pupils
  • Increased body temperature
  • Rapid heart rate
  • Increased blood pressure

The more cocaine a person uses, the more intense the high they may experience. Unfortunately, this can also cause more intense and unpredictable behaviors. Symptoms associated with increased use include:

  • Restlessness
  • Irritability
  • Anxiety
  • Panic attacks
  • Paranoia
  • Tremors
  • Vertigo
  • Muscle twitches

Cocaine use can also cause severe medical complications. These can include:

  • Irregular heart rhythms
  • Heart attacks
  • Severe headaches
  • Seizures
  • Stroke
  • Coma
  • Abdominal pain and nausea
  • Lung damage
  • Bowel decay (if ingested)
  • Loss of smell, bloody nose, runny nose, or trouble swallowing (when snorted)
  • HIV or hepatitis (when injected)
  • Death

Long-term cocaine abuse, whether mixed with alcohol or not, can permanently increase blood pressure. This is because it stresses the kidneys, which can lead to kidney failure.

Effects of Alcohol Use & Misuse

Alcohol is a legal substance in the U.S. for adults over the age of 21. Alcohol consumption, in moderation, is common for adults. Moderate drinking is one beverage for women and two for men. When alcohol consumption exceeds moderate amounts, you risk developing alcohol abuse or alcohol dependency, known as alcohol use disorder (AUD). 

When binge drinking (more than four for women and five for men) occurs more than five times in a month, this constitutes heavy drinking and alcohol abuse. Alcohol use disorder, formally known as alcoholism, occurs when a person loses control of their drinking, unable to quit.

Alcohol is a central nervous system depressant and the symptoms associated with alcohol in the bloodstream include:

  • Slowing of speech and reflexes
  • Decreased ability to control body movement
  • Problems concentrating
  • Memory lapses
  • Depression
  • Increased fatigue
  • Dehydration
  • Nausea and stomach upset
  • Slowed breathing and heart rate
  • Blurred vision
  • Reduced blood pressure
  • Reduced inhibitions and increased risky behavior
  • Poor decision-making skills
  • Loss of consciousness

Long-term alcohol abuse and alcohol use disorder (AUD) can cause serious medical complications. Damage can occur to your heart, liver, pancreas, and brain. Damage to the heart muscle, for example, can lead to an increased risk of a heart attack. Similarly, inflammation and fat around the liver from alcohol misuse can lead to liver cirrhosis and liver failure.


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Polysubstance Abuse – Combining Alcohol and Cocaine

When people combine alcohol and cocaine, the result is often polysubstance (polydrug) abuse. This refers to when someone uses more than one drug, either at different times or at the same time. 

Alcohol and cocaine affect the body in different ways. For example, cocaine users that experience anxiety or muscle twitching may turn to alcohol to relieve those symptoms. On the other hand, alcohol users that experience significant decreases in energy may turn to cocaine for energy stimulation. While people may think they are receiving benefits by mixing the two, the reality is cocaine and alcohol can be a very dangerous combination. 

Combining coke and alcohol can negatively impact your mental health over time. Since both of these substances are addictive, combining them regularly can also lead to substance abuse and addiction. 

The Dangers of Combining Cocaine and Alcohol

Cocaine and alcohol use alone contributes to many health risks. However, when combined, those risks increase. When a cocaine user consumes alcohol, the peak concentration of cocaine in the body increases by 20 percent. This increases the cardiotoxicity of cocaine in the body. In addition, the mixture of alcohol and cocaine creates another deadly byproduct that can build up and put major stress on the body.

“Clinical data indicate that the concurrent use of alcohol and cocaine is associated with increased mortality and morbidity from cardiovascular complications, hepatotoxicity, and behaviors leading to personal injury.”

Medscape – Lynn Barkley Burnett, MD, EdD, LLB(c)

Both alcohol and cocaine are toxins and harmful to the body. Therefore, your body works to remove these toxins from the blood. Once removed from the bloodstream, the liver metabolizes the substances for removal.

 Unfortunately, when both substances hit the liver at the same time, they have an interaction and cocaethylene develops. This production of cocaethylene, along with the presence of cocaine in the body, creates the increased euphoria users experience when combining the two drugs. 

Cocaethylene in the body can have deadly consequences. Some complications associated with cocaethylene include:

  • Increased toxicity in the blood
  • Higher risk of cardiovascular complications
  • Increased risk of heart attack
  • Increased risk of stroke
  • Liver toxicity and liver damage
  • Increased impulsive behaviors
  • Compromised immune system
  • Seizures
  • Increased risk of suicide
  • Increased risk of death

Treating Cocaine and Alcohol Addiction

Treatment options for both cocaine addiction and alcohol use disorder combine the use of detox, pharmacological approaches, and behavioral interventions. Unfortunately, polydrug use has a history of poorer treatment engagement and treatment outcomes. However, cognitive-behavioral therapy (CBT) is an effective approach for preventing relapse. 

Therapeutic communities (TCs) are drug-free residences in which people in recovery from substance use disorders help each other to understand and change their behaviors. This can be an effective treatment for people who use drugs, including cocaine.


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Brown, Richard A., et al. “Depression Among Cocaine Abusers in Treatment: Relation to Cocaine and Alcohol Use and Treatment Outcome.” American Journal of Psychiatry, 1 Feb. 1998, ajp.psychiatryonline.org/doi/full/10.1176/ajp.155.2.220.

Wagner, Fernando A, and James C Anthony. “From First Drug Use to Drug Dependence: Developmental Periods of Risk for Dependence upon Marijuana, Cocaine, and Alcohol.” Neuropsychopharmacology, Elsevier, 5 Jan. 2003, www.sciencedirect.com/science/article/pii/S0893133X01003670.

Carroll, Kathleen M., et al. “Treatment of Cocaine and Alcohol Dependence with Psychotherapy and Disulfiram.” Wiley Online Library, John Wiley & Sons, Ltd, 3 May 2002, onlinelibrary.wiley.com/doi/abs/10.1046/j.1360-0443.1998.9357137.x.

Gossop, Michael, et al. “Concurrent Use and Order of Use of Cocaine and Alcohol: Behavioural Differences between Users of Crack Cocaine and Cocaine Powder.” Addiction (Abingdon, England), U.S. National Library of Medicine, Sept. 2006, www.ncbi.nlm.nih.gov/pubmed/16911728.

Coffin, Phillip O, et al. “Opiates, Cocaine and Alcohol Combinations in Accidental Drug Overdose Deaths in New York City, 1990-98.” Addiction (Abingdon, England), U.S. National Library of Medicine, June 2003, www.ncbi.nlm.nih.gov/pubmed/12780362.

Di Sclafani, Victoria, et al. “Neuropsychological Performance of Individuals Dependent on Crack-Cocaine, or Crack-Cocaine and Alcohol, at 6 Weeks and 6 Months of Abstinence.” Drug and Alcohol Dependence, U.S. National Library of Medicine, 1 Apr. 2002, www.ncbi.nlm.nih.gov/pmc/articles/PMC2857526/.

Cocores, James A. “Sexual Dysfunction in Abusers of Cocaine and Alcohol.” Taylor & Francis, The American Journal of Drug and Alcohol Abuse, 7 July 2009, www.tandfonline.com/doi/abs/10.3109/00952999809001544.

Farré, Magí, et al. “Cocaine and Alcohol Interactions in Humans: Neuroendocrine Effects and Cocaethylene Metabolism.” Journal of Pharmacology and Experimental Therapeutics, American Society for Pharmacology and Experimental Therapeutics, 1 Oct. 1997, jpet.aspetjournals.org/content/283/1/164.

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