The Dangers of Mixing Cocaine and Alcohol—What Happens When You Mix

The Dangers of Cocaine Mixed with Alcohol

Cocaine and alcohol differ in their legality, availability, and perceived safety. Alcohol is legal for people over 21 across the country and available in restaurants, bars, and even grocery stores in some states in the US.[2] It’s considered safe when used in moderation.

Cocaine is an illicit drug that’s used recreationally, except for limited medical uses such as local anesthesia in specific medical procedures in the US. Despite being dangerous, cocaine is sometimes perceived as a “safe” party drug by users.
Mixing cocaine with alcohol is a common occurrence for many reasons. People may use cocaine with alcohol to increase the pleasurable feelings of each or help the effects when the cocaine euphoria subsides.

Alcohol and cocaine may be used together to balance the effects out – a dangerous proposition that can lead to unpredictable results. Instead of offsetting the effects, taking these two substances together masks the effects, leading people to misjudge their intoxication, use too much of either substance or miss the indicators of overdose.[3]

Another risk of cocaine and alcohol is sudden death from a heart attack or stroke. While heart issues are a concern with cocaine use on its own, studies indicate that the risk is 10 times higher with alcohol and cocaine combined.[4]

Cocaethylene

Combining alcohol and cocaine produces cocaethylene, a psychoactive metabolite that has similar properties to the two substances with compounded cardiotoxic effects.[5] Because cocaethylene has a longer half-life than cocaine, mixing cocaine with alcohol may experience a longer-lasting and more intense psychoactive effect.[6]

Along with the enduring euphoria, cocaethylene increases the risk of toxic effects on the heart, including an increased risk of heart attack and stroke.[7] Cocaethylene has adverse effects, including memory, intelligence, and verbal learning impairments.

What Are the Side Effects of Cocaine and Alcohol?

Whatever the motivation for using cocaine and alcohol together, combining them has serious risks to short- and long-term physical and mental health.

When you mix cocaine and alcohol, it’s more difficult to tell how intoxicated you are. As a result, you may drink more than you intend, leading to alcohol poisoning.[8] Cocaine and alcohol together also produce side effects like an irregular heartbeat, an elevated body temperature, depressed breathing, and dehydration.[9]

The risks of cocaine and alcohol aren’t limited to the physical. People who are under the influence of cocaine and alcohol can experience serious mental health effects like increased violence and aggression, whether directed at others or themselves.[10] When people have a higher blood alcohol level and cocaine in their system, they’re more likely to commit suicide.[11]

Treatment for Polysubstance Use

Using alcohol and cocaine together could indicate an alcohol use disorder, a stimulant use disorder, or a polysubstance use disorder.[12,13,14] All under the umbrella of substance use disorder in the Diagnostic and Statistical Manual of Mental Health, Fifth Edition (DSM-5), the criteria include:

• Taking a substance in a way that’s not intended
• Experiencing strong urges or cravings for substances
• Developing a tolerance to substances
• Becoming dependent on substances
• Being unable to decrease or stop the use of substances
• Continuing to use substances despite health problems, personal problems, or known dangers[15]

Medical detox is often the first step for addiction treatment. Though uncomfortable, cocaine withdrawal isn’t usually dangerous, but alcohol withdrawal can be life-threatening.[16] If polysubstance use or alcohol use disorder is suspected, medical detox is a necessity to reduce the risk of complications.

Detox forms a strong foundation for addiction treatment, but it’s not enough on its own. Following detox, it’s important to enter a formal treatment program on an inpatient or outpatient basis to address the underlying influences and motivations for substance use and addiction.

Regardless of the level of care, treatment is individualized and involves a combination of medications and therapies. There are no FDA-approved medications for stimulants like cocaine, but there are options for alcohol addiction and any co-occurring disorders.

Behavioral therapies are highly effective for treating cocaine and alcohol dependence, including cognitive behavioral therapy (CBT), a type of therapy that helps people learn to cope with difficult situations by challenging irrational thoughts and behaviors.[17]