Cocaine and Alcohol: A Toxic Mix

Cocaine has been around for many years. It comes in two chemical forms: a water-soluble powder form and fat-soluble “free base” form. The drug has anesthetic and stimulant effects.

Its influence comes on fast and is gone within a few minutes to a few hours.

How cocaine affects a person depends on many factors, such as the form and amount used and whether it’s smoked, snorted, injected, or taken orally. Typical effects include:

• joy from a boost in dopamine in the brain
• more energy
• more talkative
• mentally alert
• more reactive to lights, touch, and sounds

Other side effects of cocaine include:

• rise in body temperature
• nausea
• moodiness
• shakes and restlessness
• increased heart rate and blood pressure
• heart rhythm problems
• heart muscle problems
• anxiety, paranoia, panic attacks
• drug tolerance and dependence, which can cause people to use higher doses and use more often
• infections
• nosebleeds
• asthma

NOTE: This isn’t a full list of cocaine’s side effects.

Alcohol is a depressant. It affects the brain, including your:

• thinking
• behavior
• mood
• movement
• judgment

Drinking too much at once (binge drinking) or heavily drinking for a long stretch of time can damage vital organs, including the:

• heart
• liver
• pancreas
• brain

Excessive alcohol use may cause:

• high blood pressure
• heart rhythm problems
• heart muscle damage
• stroke
• liver inflammation, fatty liver, liver cirrhosis
• inflammation of the pancreas
• cancer

Increased toxic effects

Using cocaine with alcohol creates new elements. One of the most powerful of these metabolites is called cocaethylene.

This product is stronger than either cocaine or alcohol alone. It increases toxicity to the heart, liver, and other major organs.

Longer method of action

Cocaethylene also stays around for a much longer time in the body than cocaine, and its toxic effects last longer. Alcohol also slows the removal of another metabolite, ethylbenzoylecgonine, from the kidneys. This raises the blood levels of cocaine and cocaethylene.

Increased risk of stroke

Sudden stroke is possible when using both cocaine and alcohol. Cocaine increases the risk of stroke by:

• shrinking blood vessels
• raising heart rate and blood pressure
• causing sudden brain bleeding
• increasing risk of blood clots

Cocaethylene can raise the risk of stroke even more because it can stay around in the body for days to weeks.

Increased alcohol consumption

Research finds that alcohol can increase cravings for cocaine. This can make it harder to stop using. People may binge-drink to continue feeling its effects and keep withdrawal at bay.

Increased impulsivity

Both cocaine and cocaethylene raise levels of the brain chemicals dopamine and serotonin and block their reuptake. This increases stimulant effects on the body, which can lead to:

• impulsive and violent behavior
• panic attacks
• anxiety
• depression

Increased risk of heart-related problems

The rise of cocaethylene and cocaine increases heart and liver toxicity. The biggest danger of using both are sudden heart-related problems, such as a heart attack or change in heart rhythms.

The level of risk may increase if a person already has heart-related health issues.

Plasma and liver enzymes break down cocaine into two major metabolites: benzoylecgonine and ecgonine methyl ester. The body removes them through urine. These metabolites can be detected in urine for up to 36 hours, in blood for two days, and in hair for months.

When people mix cocaine and alcohol, cocaethylene can stay around for days to even weeks in the body. Total duration depends on how much is used and how it’s consumed. How your liver, pancreas, and kidney are working also play into duration time.

Studies show alcohol and cocaine use during pregnancy have negative effects on both mother and fetus. These effects can have a lasting health impact on both mother and child.

Using cocaine and alcohol at the same time can greatly increase these dangers. Combining these substances during pregnancy can cause:

• miscarriage
• stillbirth
• premature birth
• low birth weight
• developmental delays, like problems with learning, attention, emotions, and physical and mental development

The dangers depend on the individual, including:

• other health problems they may have
• how long cocaine and alcohol were used
• whether other drugs were used during pregnancy

One reason people use alcohol and cocaine together might be because they believe alcohol can curb the withdrawal and anxiety when cocaine’s effects start to wear off.

However, alcohol can increase cravings for cocaine. This creates a cycle of misuse of both.

It also causes toxic levels of cocaine metabolites to build in the liver. That increases the risk of stroke and heart-related reactions for days to weeks.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 14 million people met the criteria for alcohol use disorder (AUD) in 2017 in the United States.

Around 966,000 people met criteria for substance use disorder (SUD). More than 2 million had both AUD and SUD.

Dependence means the body has become used to a drug and needs it to function. Addiction, on the other hand, is a set of behaviors. It’s the compulsive use of a drug despite negative consequences, whether they’re social, financial, legal, etc.

Signs of cocaine and alcohol dependence include:

• behavior changes
• sleep and mood shifts
• anxiety
• nausea and vomiting
• dizziness
• depression
• headache
• weight loss
• runny nose, nosebleeds
• dilated pupils
• increased heart rate or blood pressure

There are many reasons that go into why someone may have a higher risk for substance misuse and dependence. These include:

• genetics
• sex
• age
• race
• environment
• lifestyle factors (like stress, diet, and exercise)

Some research suggests biomarkers for stress and organ damage may help predict SUD risk, but more work needs to be done in this area.

Cocaine dependence develops when there’s a change in the brain’s reward system from constant release of dopamine. After a while, you need more of the drug to get the same desired feelings and to avoid withdrawal.

Cocaine also causes changes to other brain chemicals like norepinephrine and serotonin.

Withdrawal symptoms can include:

• irritation
• poor sleep
• depression
• lack of appetite, focus, and energy
• poor impulse control
• poor decision-making
• paranoia
• unclear thinking

If you think you or a loved one might have a problem with cocaine, alcohol, or another substance, reach out to a healthcare provider. They can work with you to find the best treatment option.

The following organizations can also help you get local help and support:

• SAMHSA Treatment Provider Locator
• Alcoholics Anonymous
• Narcotics Anonymous

Al-Anon and The Support Group Project can help you cope if you have a loved one dealing with an SUD.

If you or someone you know is in immediate danger of hurting themselves, reach out to the National Suicide Prevention Lifeline at 800-273-TALK for free, confidential help 24/7.

Cocaine is often used with alcohol. This co-use increases the harmful effects of cocaine as well as the risk of drug dependence and addiction.

When these two substances combine, they create a more powerful metabolite called cocaethylene. It can stay around for a much longer time in the body and cause damage to major organs.

Currently, there’s no Food and Drug Administration–approved treatment for cocaine dependence. Research is being done on vaccines and gene- and biomarker-based treatment models.

Disulfiram is one drug that’s approved to treat alcohol dependence. It may also work in some people to treat cocaine dependence. Other medications to treat cocaine dependence are being used off-label with limited success.

Cognitive behavioral therapy, peer recovery support, and other symptom-management treatments can also treat and manage drug dependence.