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Cocaine and Alcohol

Cocaine and alcohol mix is a common form of polysubstance abuse, with the combination being particularly dangerous due to the creation of cocaethylene, which can severely damage the heart.

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What Is Cocaethylene?

Cocaethylene is a psychoactive metabolite created in the body when mixing cocaine and alcohol (ethanol). A metabolite is a chemical made in the body while breaking down drugs or food. As the body breaks down cocaine and alcohol, it creates cocaethylene.

Like cocaine, cocaethylene stops the reabsorption of dopamine, a powerful neurotransmitter that’s associated with feelings of pleasure and reward. The effect on dopamine only reinforces pleasure-seeking behavior, feelings of pleasure, and lapses in judgment.

Cocaethylene has similar properties to cocaine but has a longer half-life and may be more cardiotoxic. That means users may notice long-lasting, intense effects that can damage the heart.

The higher the level of cocaethylene in the body, the more serious the adverse effects will become.

Stimulants VS Depressants

Stimulants and depressants are two umbrella terms for two different types of substances. Stimulants are often called “uppers” and provide feelings of extreme energy, focus, and high mood.

Conversely, depressants work by inhibiting the central nervous system, which slows the heart rate and gastrointestinal and respiratory systems.

When mixing these two different types of substances, like cocaine and alcohol, the body and mind become impaired by the conflicting messages they receive.

Common examples of stimulants include:

  • Caffeine
  • Nicotine
  • Methamphetamine (meth)
  • Cocaine/crack cocaine
  • Adderall
  • Ritalin
  • MDMA (ecstasy)

Common examples of depressants include:

  • Alcohol
  • Xanax
  • Valium
  • Barbiturates
  • GHB (Gamma-hydroxybutyrate)
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Dangers of Mixing Cocaine and Alcohol

Cocaine abuse and alcohol abuse can be dangerous on their own.

Cocaine use can cause an increased risk of heart attack, seizures, and damage to the lungs, heart, and stomach. The effects of alcohol use can lead to damage to the heart, liver, pancreas, brain, and immune system.

Mixing them not only enhances the effects of cocaine and alcohol but can lead to life-threatening health issues due to cocaethylene toxicity.

Short-term effects of mixing cocaine and alcohol:

  • High blood pressure
  • Raised body temperature
  • Intense drug cravings
  • Paranoia
  • Liver damage
  • Worsened compulsive or violent behavior
  • Increased risk of stroke
  • Increased risk of heart attack
  • Increased risk of sudden death
  • Increased risk of lethal hyperthermia

Long-term effects of mixing cocaine and alcohol:

  • Heart arrhythmia
  • Worsened mental health issues like depression and anxiety
  • Worsened substance use issues
  • Cocaine addiction
  • Alcohol use disorder
  • Increased risk of cancer
  • Increased liver damage and cardiovascular damage

Get Help for Cocaine and Alcohol Addiction

Mixing a cocaine high with high alcohol consumption can be incredibly dangerous. If you or a loved one has issues with mixing these two substances, now is the time to seek addiction treatment before the health problems become life-threatening.

Regardless of whether inpatient or outpatient treatment is needed, there are providers ready to help you avoid the life-threatening risks of mixing cocaine and alcohol. Talk to your doctor or an addiction specialist about the best treatment options for you.

If you’re unsure where to start, you can try programs like Alcoholics Anonymous (AA), SMART Recovery, or Narcotics Anonymous (NA).

You can also try SAMHSA’s online treatment locator or call 1-800-662-4357 (HELP) to see what drug addiction treatment is offered in your area.

FAQs About Cocaine and Alcohol

What is cocaethylene?

Cocaethylene is a chemical formed in the body caused by cocaine and alcohol interaction. The more of these two substances are mixed, the more cocaethylene is produced in the body and the higher risk you have of intense effects and dangerous health issues.

Cocaethylene has similar effects to cocaine, but it stays in your system for much longer and has the potential to be cardiotoxic (dangerous to the heart).

Why do people use cocaine and alcohol together?

Mixing drugs, also known as polysubstance use, is very common with substance abuse. Cocaine and alcohol are often mixed because one is a stimulant, and one is a depressant.

Many drug users believe the mixture will prevent the user from feeling too “up” or too “down” and be somewhere in the middle.

Unfortunately, this mixture does not create a “balanced” feeling; instead, it causes impairment and possibly dangerous health effects. The mixing of cocaine and alcohol leads to the creation of cocaethylene, a chemical with intense effects that can cause heart damage at high levels.

How does mixing cocaine and alcohol affect the body?

Mixing cocaine and alcohol can increase your risk for sudden stroke, heart attack, and death. The mixture also causes higher levels of cocaethylene to be made in the body, a chemical with powerful psychoactive effects that can lead to heart damage.

Aside from negative health effects, mixing cocaine and alcohol can increase violent and compulsive behavior. Physical violence and car crashes are common outcomes of this type of drug use.

Is it really that dangerous to mix cocaine with alcohol?

Yes. The concurrent use of cocaine and alcohol causes the body to create a metabolite called cocaethylene. Cocaethylene has similar effects to cocaine but is more intense and stays in your system much longer.

Because cocaethylene is cardiotoxic at high levels, the danger of sudden death, heart attack, or stroke is a serious concern among healthcare professionals. Aside from the dangers of cocaethylene, polysubstance use with cocaine and alcohol can lead to alcohol dependence and cocaine addiction.

What are the side effects of mixing cocaine and alcohol?

Common side effects of mixing cocaine and alcohol include:

  • Strong drug cravings
  • High blood pressure
  • Heart arrhythmia
  • Paranoia
  • Liver damage
  • Worsened compulsive or violent behavior
  • Worsened mental health and drug abuse issues
  • Increased risk of stroke and heart attack
  • Increased risk of sudden death
  • Increased risk of fatal hyperthermia
  • Increased liver damage and cardiovascular damage
  • Increased risk of cancer
Kent S. Hoffman, D.O. is a founder of Addiction HelpReviewed by:Kent S. Hoffman, D.O.

Chief Medical Officer & Co-Founder

  • Fact-Checked
  • Editor

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.

Jessica Miller is the Content Manager of Addiction HelpWritten by:

Editorial Director

Jessica Miller is the Editorial Director of Addiction Help. Jessica graduated from the University of South Florida (USF) with an English degree and combines her writing expertise and passion for helping others to deliver reliable information to those impacted by addiction. Informed by her personal journey to recovery and support of loved ones in sobriety, Jessica's empathetic and authentic approach resonates deeply with the Addiction Help community.

  1. Centers for Disease Control and Prevention. (2022, February 23). Polysubstance Use Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/stopoverdose/polysubstance-use/index.html
  2. Farooq, M. U., Bhatt, A., & Patel, M. (2009, September). Neurotoxic and Cardiotoxic Effects of Cocaine and Ethanol. Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550388/
  3. Pennings, E. J. M., Leccese, A. P., & de Wolff, F. A. (2002, July). Effects of Concurrent Use of Alcohol and Cocaine. Addiction (Abingdon, England). https://pubmed.ncbi.nlm.nih.gov/12133112/
  4. Pergolizzi, J., Breve, F., Magnusson, P., LeQuang, J. A. K., & Varrassi, G. (2022, February 22). Cocaethylene: When Cocaine and Alcohol Are Taken Together. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8956485/
  5. U.S. Department of Health and Human Services. (2022, May 2). What Is Cocaine? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/cocaine/what-cocaine

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