Cocaethylene Effects and Dangers: The Product of Cocaine and Alcohol Use

3 min read · 4 sections

According to the Journal of Medical Toxicology, when a person uses both alcohol and cocaine, the substances form a very unique substance known as cocaethylene as result of the substances being metabolized in the liver.1 Cocaethylene, also known as ethylbenzoylecgonine, has some significant effects of its own.

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How Cocaethylene Is Produced

According to The Neurochemistry of Abused Drugs, the production of cocaethylene occurs in the liver. The liver is the main organ that is associated with the detoxification process.2

Whenever a person consumes any substance, there are a number of waste products, and some substances can build up in the system and be harmful. When certain harmful substances and/or waste products accrue in the bloodstream, they are processed through the liver where the natural process of metabolism breaks them down so they can be eliminated from the body, typically through urine.

Cocaine and alcohol are toxic substances that are harmful to the bodily tissues, and they are removed from the bloodstream and metabolized in the liver in order to eliminate them from the body. When an individual uses alcohol and cocaine at the same time, cocaethylene develops in the liver as a result of the metabolic processing of both alcohol and cocaine.

It is hypothesized that cocaethylene develops in the liver as a result of the metabolism of cocaine being altered by the presence of alcohol. Researchers believe that cocaethylene is produced in the liver about two hours after an individual has used the two drugs. Researchers suggest that about 20 percent of the cocaine being metabolized in the liver is disrupted by alcohol (producing cocaethylene), and when the liver attempts to eliminate the cocaethylene it has produced, the alcohol in the system slows down the process, leaving about 20 percent of the cocaethylene remaining in the system.

As individuals continue to drink alcohol, this continued alcohol consumption begins to disrupt the elimination of cocaethylene in the liver, and it begins to pass from the liver into the bloodstream where it can affect a number of tissues and organs. The addition of cocaethylene to the alcohol and cocaine already in the system can produce effects that are much more powerful than the effects that alcohol or cocaine alone produce.

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Effects of Cocaethylene

The effects of cocaethylene in the liver and bloodstream are more salient in those who use both alcohol and cocaine together on a regular basis; however, some of the effects, such as sudden heart attacks or impulsive behaviors, may even occur in occasional users who combine the two drugs.

Some of the effects of the production of cocaethylene include:

  • Increased toxic effects: Cocaethylene is significantly more toxic than cocaine. Laboratory studies suggest that it may have a toxicity level 30 percent higher than cocaine. Once the liver begins producing it, the chemical keeps being released in the system and remains in the body up to three times longer than cocaine, resulting in increased potential for toxic effects. Cocaethylene toxicity may be associated with a number of sudden deaths and cardiovascular events that occur in cocaine users.3
  • Increased risk of cardiovascular issues: Cocaethylene increases heart rate and blood pressure even more than cocaine does. In addition, it impairs the ability of the heart muscle to contract. These issues are believed to increase the risk even further for people using only alcohol or cocaine alone and cause significant cardiovascular issues.4
  • Increased risk for stroke: Cocaethylene may also result in an increased risk for stroke compared to individuals who only use alcohol or cocaine.
  • Increased potential for liver damage: Because of its significant toxicity, the presence of cocaethylene in the liver will add to the potential to develop liver damage compared to the use of alcohol or cocaine alone.5
  • Greater perceived effects of both drugs: Cocaethylene blocks the reuptake of dopamine in the brain, producing greater euphoric effects for both cocaine and alcohol and also increasing the potential that an individual will continue to abuse both drugs.6
  • Longer method of action: Cocaethylene has a greater half-life than cocaine; therefore, it is more slowly eliminated than cocaine. This results in potentially more serious effects as it remains in the system longer.7
  • Increased alcohol consumption: A number of studies suggest that the presence of cocaethylene may actually result in increased alcohol consumption. Individuals who use cocaine and alcohol together often binge drink. Chronic binge drinking is associated with a number of issues, including liver damage, cardiovascular issues, nerve damage, alcohol poisoning, poor judgment, and a quicker development of severe alcohol dependence.8
  • Increased impulsivity: Cocaethylene’s affinity to increase both dopamine and serotonin levels in the brain increases the risk that an individual will engage in more impulsive behaviors, including potential violence.9
  • Potential for death: The National Institute on Drug Abuse (NIDA) has suggested that alcohol and cocaine may be the most common two-drug combination that results in fatalities.10

Other Complications of Polysubstance Abuse

In addition to the above effects, individuals who chronically and habitually abuse multiple drugs together are at risk to develop a number of significant substance use disorders. In the case of concurrent alcohol and cocaine use, individuals who develop both an alcohol use disorder and a cocaine use disorder will develop a number of complications that require very specialized treatment interventions.

These individuals are also at serious risk for potentially fatal issues associated with discontinuing alcohol. A percentage of individuals who have moderate to severe alcohol use disorders are at risk to develop potentially fatal seizures during the withdrawal period and/or a condition known as delirium tremens (DTs) that consists of marked confusion, hallucinations, and a number of other negative physical effects. Because chronic and habitual combined use of alcohol and cocaine can exacerbate the symptoms of both alcohol and cocaine abuse, and increase the risk for the development of complications, it would be expected that these individuals are also at an increased risk for the development of severe issues with physical dependence on both substances.

Individuals entering treatment as a result of combined use of alcohol and cocaine face a number of difficult challenges. Treatment providers will need to address the use of both substances concurrently as well as any co-occurring physical and mental health disorders, such as depression, personality disorders, anxiety, etc. Treatment for individuals who have a number of different co-occurring disorders can become very complicated, and it is often fraught with setbacks and potential relapses. These issues are even further complicated by the effects to the body and mind that occur as a result of the prolonged effects of cocaethylene.

That being said, there is always hope for recovery. With comprehensive care, individuals who regularly abuse cocaine and alcohol together can effectively leave this abuse in their past and move forward into a healthier future.


  1. Farooq, M. U., Bhatt, A., & Patel, M. (2009). Neurotoxic and cardiotoxic effects of cocaine and ethanol. Journal of medical toxicology : official journal of the American College of Medical Toxicology5(3), 134–138.
  2. Karch, S. B. (2008). Neurochemistry of abused drugs. CRC Press.
  3. Andrews P. (1997). Cocaethylene toxicity. Journal of addictive diseases16(3), 75–84.
  4. Pennings, E. J., Leccese, A. P., & Wolff, F. A. (2002). Effects of concurrent use of alcohol and cocaine. Addiction (Abingdon, England)97(7), 773–783.
  5. Treadwell, S. D., & Robinson, T. G. (2007). Cocaine use and strokePostgraduate medical journal83(980), 389–394.
  6. Hearn, W. L., Flynn, D. D., Hime, G. W., Rose, S., Cofino, J. C., Mantero-Atienza, E., Wetli, C. V., & Mash, D. C. (1991). Cocaethylene: a unique cocaine metabolite displays high affinity for the dopamine transporter. Journal of neurochemistry56(2), 698–701.
  7. Jatlow P. (1993). Cocaethylene: pharmacologic activity and clinical significance. Therapeutic drug monitoring15(6), 533–536.
  8. McCune, A. (2015). Abc of Alcohol. John Wiley & Sons Inc.
  9. Macdonald, S., Erickson, P., Wells, S., Hathaway, A., & Pakula, B. (2008). Predicting violence among cocaine, cannabis, and alcohol treatment clients. Addictive behaviors33(1), 201–205.
  10. NIDA. (2021, April 8). Cocaine DrugFacts. 
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