Medically Reviewed

Effects and Dangers of Mixing Cocaine & Alcohol

3 min read · 3 sections
While the two substances are often used together for recreational purposes, combining cocaine and alcohol can be dangerous.
What you will learn:
The dangers of mixing cocaine and alcohol
Cocaethylene and its effects
How to get help for cocaine and alcohol addiction

Combining Cocaine and Alcohol

Individuals who use stimulants like cocaine commonly also use other substances such as alcohol, a depressant.1 One meta-analysis found that rates of concurrent cocaine and alcohol use ranged from 37% to 96%.2. Another 2018 meta-analysis indicated an estimated 74% prevalence rate of simultaneous alcohol use among people who used cocaine.3,4 And among individuals with a cocaine use disorder, nearly 60% also have an alcohol use disorder.5

While the two substances are often used together for recreational purposes, combining cocaine and alcohol can be dangerous, causing cardiotoxic effects and increasing an individual’s risk of a potentially fatal overdose.2,6

If you or someone you care about use alcohol and cocaine, you should be aware of the potential risks and dangers.

The Dangers of Mixing Alcohol and Cocaine

Individuals who use cocaine and alcohol concurrently may do so for a variety of reasons. They may wish to increase the pleasurable and rewarding effects of each substance, use alcohol to reduce anxiety that can occur once cocaine’s euphoric effects wear off, or to balance or cancel out the effects of the other drug—a common and dangerous misconception that many have about mixing a stimulant (cocaine) and a depressant (alcohol).3,4,6 Instead of balancing each other out, cocaine and alcohol’s combined effects can be unpredictable, even life-threatening.6

Using the substances in combination can cause the substances to mask the effects of the other. As a result, an individual may misjudge their level of intoxication or the amount they’ve taken, use more of one or both substances, and potentially overdose.6

Studies indicate that the risk of sudden death—from heart attack or stroke—as a result of the concurrent use of cocaine and alcohol together was 18 times higher than from using cocaine alone.1,7

Additionally, combining alcohol and cocaine causes the liver to form a substance known as cocaethylene. Cocaethylene is equal in potency to cocaine, producing feelings of energy, focus and excitement, but has a longer . This can extend the cocaine high many people who take cocaine experience, even if they are unaware that the combination is extending the effects.8 The drug combination also increases the risks of dangerous and toxic effects on your cardiovascular system, including heart attack and stroke.1,9 Additionally, research indicates that combining the substances concurrently can negatively impact intelligence, memory, and verbal learning, compared with taking either substance alone.1

What is Cocaethylene?

Cocaethylene is a hazardous created when cocaine and alcohol are used together. This byproduct, an entirely new psychoactive substance, is similar to cocaine in potency but longer lasting.8

Like cocaine, cocaethylene blocks the reuptake of dopamine—the body’s natural reward chemical that is associated with movement, motivation, and reward-seeking behavior—which reinforces dopamine’s reinforcing effects and contributes to an individual’s increased feelings of pleasure, energy, focus, and excitement.8,9 At the same time, however, it increases the risk of serious health effects, including:3

  • Sudden death through lethal heart attack, stroke, or hyperthermia.
  • Sudden death attributed to cocaine-related violent death (e.g., car crashes, gunshots, strangulations).
  • Liver problems, such as fibrosis and liver toxicity, which make admittance to hospital intensive care units more likely.

For individuals who chronically use cocaine, cocaethylene increases the risk of experiencing persistent and potentially longer-lasting panic and anxiety attacks.3

Treatment Options for Cocaine and Alcohol Addiction

Treatment for unhealthy substance use can help you overcome addiction and regain control of your life. The recovery process might start with professional detox, which can help you stay as safe and comfortable as possible as you undergo withdrawal.10,11

Although withdrawal from stimulants, like cocaine, can be uncomfortable, it is not typically life-threatening. Untreated alcohol withdrawal, however, can be severe and fatal, which is why proper detox treatment for many people with alcohol addiction is so important.10

Detox is generally not enough to sustain lasting abstinence. A formal treatment program—that addresses the underlying issues associated with addiction—can help you understand and change the thoughts, emotions, and behaviors that led to problematic substance use and addiction, as well as teach you coping skills and other techniques to avoid relapse or a return to drug use.11

Treatment can take place in different settings, such as inpatient or outpatient facilities, depending on your needs, and usually involves a combination of medications and different forms of therapy.5

There are currently no medications approved by the U.S. Food and Drug Administration (FDA) for treating stimulant withdrawal or addiction.10 However, medications can be used as tools to help reduce or avoid alcohol.5 Studies suggest that the combined treatment of pharmacotherapy and counseling for concurrent cocaine and alcohol dependence can significantly reduce both cocaine and alcohol use, including a reduction in heavy drinking.5

Counseling and behavioral therapies, such as contingency management (CM) or cognitive-behavioral therapy (CBT) play an important role in the treatment of cocaine and alcohol misuse and addiction.5 CM rewards you for remaining substance-free, while CBT can help you learn to identify and correct harmful behaviors, learn skills to avoid substance use, and address other co-occurring problems.5,11,12

If you’re ready to reach out for help, please contact American Addiction Centers (AAC) at to learn more about treatment, resources, and support.

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