Mixing Cocaine and Alcohol: Understanding Cocaethylene and Its Risks

Mixing cocaine and alcohol can have dangerous consequences. Combining a stimulant drug, like cocaine, with a depressant, like alcohol, increases the risk of unpredictable and adverse effects, largely due to the production of a toxic compound called cocaethylene. Cocaethylene can permanently damage the heart, liver and other major organs in the body.^1,2

In this article, we will examine what cocaethylene is, explore its short and long-term effects on the body, and highlight the importance of seeking professional treatment for cocaine and alcohol addiction. 

At Smarmore Castle, we offer comprehensive cocaine and alcohol addiction treatment. Our dedicated and experienced clinical team deliver personalised inpatient therapy and aftercare to support lasting abstinence and positive recovery experiences. 

What Is Cocaethylene? 

If you take cocaine and alcohol at or around the same time, a new substance is formed in the body. This is known as ‘cocaethylene’.³

Cocaethylene is a breakdown product of cocaine that is produced in the liver in the presence of alcohol. This toxic compound is formed when alcohol and cocaine are taken within around two hours of each other.⁴

How Is Cocaethylene Formed in the Body?

Cocaethylene is a toxic substance produced in the liver when cocaine and alcohol are consumed together. Normally, the body breaks down cocaine into inactive byproducts using blood and liver enzymes. However, the presence of alcohol alters this process, causing some of the cocaine to be converted into cocaethylene instead.

Compared to cocaine, cocaethylene stays in the body much longer – it takes about two hours for half of it to be eliminated, which is two to five times longer than cocaine. It can remain in the system for days or even weeks, leading to prolonged effects.

Cocaethylene also poses greater risks to the body, particularly the heart, and is considered more toxic than cocaine alone.^1,3,4

How Does Mixing Cocaine and Alcohol Affect the Brain?

Like cocaine, cocaethylene is psychoactive, meaning that it affects how your brain functions. It can cause changes in your awareness, mood, thoughts, emotions and behaviours, some of which can be harmful or distressing.

Cocaethylene influences the functioning of chemical messengers (neurotransmitters) in the brain and body. It particularly affects dopamine, a neurotransmitter and hormone that plays a role in the reward system and helps with motivation and planning. A surge of dopamine is released in the brain if you do something that makes you feel good. By blocking reuptake, both cocaine and cocaethylene keep dopamine levels high in the brain, maintaining pleasurable effects. This reinforces feelings of happiness and reward and contributes to their psychoactive effects.^3-6

Why Do People Mix Cocaine and Alcohol?

People drink alcohol when using cocaine for a number of reasons. Cocaine and alcohol are commonly used together at parties or in nightclubs if the user has access to both at the same time. Some people may drink alcohol to prolong the high and dampen down withdrawal effects from cocaine. Ironically, drinking alcohol intensifies cocaine cravings.

If you are drinking alcohol to avoid withdrawal effects and to maintain the rewarding effects of cocaine, you may be making it more difficult to stop. Using these two substances together can make you drink more alcohol and produce a vicious cycle of misuse.^1,3,4

Effects of Mixing Cocaine and Alcohol 

Using cocaine alongside alcohol is dangerous as the toxic effects of both substances are enhanced. Like cocaine, cocaethylene is psychoactive, meaning that it affects how your brain functions. It can cause changes in your awareness, mood, thoughts, emotions and behaviours, some of which can be harmful or distressing. As cocaethylene persists for longer in the body, it can bring about more toxic and longer-lasting effects than alcohol or cocaine alone.^4,5 

Short-Term Effects of Cocaethylene

In the short term, cocaine has stimulating effects on the brain and body. Signs and symptoms of cocaine use include: 

• Higher energy 
• Increased alertness 
• Raised body temperature 
• Increased blood pressure
• Anxiety 
• Paranoia 
• Irritability or aggression 

On the other hand, alcohol is a depressant. This means that it relaxes you and has the following effects: 

• Delayed reaction times
• Reduced coordination
• Memory lapses 
• Low mood 
• Reduced inhibition 

Combining these two substances can have unpredictable and hazardous outcomes. As toxic cocaethylene accumulates in the body, severe and sometimes fatal effects can occur.⁷  

Physical Health Risks of Cocaethylene

Some people may feel that taking these two substances together is relatively risk-free, however, research shows that this is not the case. Taking alcohol alongside cocaine increases your risk of sudden death, compared to using cocaine on its own.⁴

Compared with using one substance, mixing alcohol and cocaine raises the risk of experiencing severe acute and chronic effects, such as:

• Heart attack 
• Stroke 
• Heart damage 
• Liver damage
• Organ failure 

Excessive use of either substance carries health risks, particularly for the heart and liver. Formation of cocaethylene in the body increases the risk of serious adverse reactions, including the potential for life-threatening complications.⁷

Mental Health Risks of Mixing Cocaine and Alcohol

Long-term misuse of alcohol and cocaine can have negative impacts on mental health and worsen existing conditions. Cocaethylene is a powerful psychoactive substance that can impact your mental functions, emotions and behaviours. You may become more anxious or paranoid and may engage in uncharacteristically aggressive behaviours. On the other hand, your mood could dip, and you may experience suicidal thoughts or ideas. Increased risk of suicide is a recognised risk associated with mixing cocaine and alcohol.⁷

If you are experiencing thoughts or ideas for ending your life, you are not alone. Free support is available through organisations such as NHS 111, Samaritans and SOS Silence of Suicide.⁸

Medical Emergencies Related to Cocaethylene 

As alcohol is a depressant and cocaine is a stimulant, some people may take them together to counteract negative effects. However, this can make you want to take more of either, or both, substances, which increases overdose risks.⁷

Overdoses are medical emergencies that can be fatal. If you are suspicious of overdose, you should contact emergency services immediately, place the person in the recovery position and stay with them until help arrives.²

Taking alcohol alongside cocaine can make you feel less intoxicated and make you want to drink more. If you consume too much alcohol for your body to process, this can lead to alcohol toxicity, or poisoning. Alcohol poisoning is dangerous as the depressant effects of alcohol on the body are amplified. This can produce symptoms such as a reduced breathing rate, confusion, seizures and loss of consciousness. Again, you should seek medical help immediately if you or someone around you is experiencing the effects of alcohol poisoning.^7,9 

Cocaine and Alcohol Addiction

Combining cocaine with alcohol can make you feel less intoxicated than you are. This not only places you at risk of harm but can also increase your alcohol consumption.⁹ 

If you regularly consume excessive amounts of alcohol you can develop addiction. This is when you feel that you need alcohol to function physically or mentally. Because of this, you may continue to drink alcohol despite negative consequences. You may take risks, struggle to cut down, feel you need to drink more to get the same effects or lose friends, hobbies or your job, as a result of your drinking habits. These are all signs of alcohol dependence, or addiction. 

Similarly, if you are using cocaine regularly, especially over extended periods, you can develop a cocaine use disorder. As with an alcohol use disorder, you struggle to control use and persistently take cocaine despite negative impacts on your health and social well-being.¹⁰ 

In some cases, as cocaine is commonly taken with alcohol, you can develop cocaine and alcohol dependence. This is also known as a polysubstance use disorder. Struggling with addiction to two substances is extremely challenging and can quickly overwhelm your day-to-day life. You may want to hide away from friends and family and neglect your usual responsibilities to use cocaine and drink alcohol.¹¹ 

If you’re finding it difficult to reduce or stop using alcohol and cocaine, it may be helpful to explore professional advice and support. At Smarmore Castle, we provide cocaine and alcohol rehab to help you begin your life in recovery.

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Getting Help for Cocaine and Alcohol Addiction

If you or a loved one is struggling with the effects of cocaethylene, or you’re concerned about cocaine and alcohol addiction, we’re here to help. At Smarmore Castle, we offer expert-led, confidential treatment programmes for drug and alcohol dependence. We also provide family therapy and support for loved ones. Call us, email or fill out our secure online enquiry form today to speak with an admissions specialist or to schedule an initial assessment and take the first step towards recovery.

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