Mixing Cocaine and Alcohol

Written by Jonathan Strum

& Medically Reviewed by Benjamin Caleb Williams, RN

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Last Updated - 12/12/2022

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Alcohol is often used alongside other illicit substances, leading some people to wonder what happens when you mix alcohol and cocaine. Cocaine mixed with alcohol can lead to dangerous, even life-threatening consequences due to the formation of a toxic chemical called cocaethylene. For this reason, it is critical to avoid using alcohol and cocaine together.

What Is Cocaine?

Cocaine is a stimulant drug that has some medical uses but is primarily used recreationally to get high. It is an illegal drug, and it works by stimulating the body and releasing endorphins in the brain. The release of endorphins causes the euphoric feeling of a high, while the stimulation of the brain and body leads to a feeling of increased confidence, energy and ability.

While cocaine is often used to feel good, it causes increased stress on the body, especially on the heart. It can lead to increased blood pressure and heart rate, increasing the risk of a heart attack or stroke occurring. Cocaine can also cause addiction to develop, which makes someone seek out and use the drug despite negative consequences.

Can You Mix Cocaine and Alcohol?

You should never mix cocaine and alcohol. Cocaine is a stimulant, while alcohol is a depressant. Because one drug causes increased stimulation and the other suppresses the body’s normal systems, the effects can cancel each other out while still creating a toxic effect. This can cause someone to take too much of these substances because they don’t realize how much they have used.

Additionally, mixing cocaine and alcohol can cause a chemical reaction in your bloodstream that creates a chemical called cocaethylene. This chemical can be dangerous, as it increases your risk of medical problems.

Side Effects of Mixing Cocaine With Alcohol

Cocaine and alcohol have contrasting effects on the body. Cocaine is a stimulant that increases brain activity, while alcohol is a depressant that decreases brain activity. When used together, cocaine and alcohol produce a high characterized by a heightened and prolonged euphoria.

This intensified response may be due to enhanced levels of the chemical dopamine within the central nervous system. The combination of cocaine and alcohol may also limit alcohol’s sedative effects and decrease withdrawal symptoms when coming down from a cocaine high. However, combining these substances can also increase the risk of cocaine and alcohol cardiotoxicity and neurotoxicity.

Side effects of cocaine and alcohol use include increased risk of:

  • High blood pressure
  • Abnormal heart rhythm and heart attack
  • Brain damage and stroke
  • Risky, impulsive behavior
  • Reduced cognitive function and memory problems
  • Motor control problems
  • Breathing difficulties

Cocaine and Alcohol Overdose

Using cocaine and alcohol together significantly increases the risk of an overdose. Without rapid treatment, overdose from cocaine or alcohol can be fatal. It is critical to seek emergency medical help immediately if someone is suffering from a suspected cocaine or alcohol overdose.

Overdose symptoms include:

  • Irregular heartbeat
  • Vomiting
  • Difficulty breathing
  • Excessive sweating
  • Dilated pupils
  • Hallucinations
  • Loss of consciousness
  • Seizures
  • Heart attack
  • Stroke

What Happens if You Mix Cocaine and Alcohol? 

When you mix cocaine and alcohol, it can cause a cocaine and alcohol metabolite called cocaethylene to form. This is a very dangerous alcohol and cocaine interaction, as this metabolite increases the risk of sudden death by up to 25 times when compared to the use of cocaine on its own.

What Is Cocaethylene?

When used together, cocaine and alcohol are metabolized within the body to produce a chemical called cocaethylene. Cocaethylene is not cocaine, but it has a similar structure to the drug. It has a longer duration of action within the brain and is more toxic than cocaine alone. Cocaethylene is believed to alter dopamine function within the brain, enhancing feelings of euphoria associated with combined cocaine and alcohol use.

The build-up of this toxic chemical is responsible for some of the dangerous side effects that occur when mixing cocaine and alcohol, including liver damage and cardiovascular and neurovascular damage.

Cocaethylene Withdrawal

Cocaine and alcohol hangovers can occur even after short-term substance use. Hangover symptoms include muscle aches, headache, fatigue and nausea. Some people may use alcohol to ease cocaine hangover symptoms or use cocaine to ease alcohol hangover symptoms.

After prolonged or repeated substance use, the body can develop a physical dependence on alcohol and cocaine. Once the body has formed a dependence, unpleasant and potentially dangerous withdrawal symptoms occur when drug use is stopped. While withdrawal from alcohol or cocaine alone is challenging, withdrawal symptoms can be even more severe when both substances are mixed.

Withdrawal symptoms of cocaethylene include:

  • Irritability
  • Extreme fatigue
  • Depression
  • Hyperactivity
  • Insomnia
  • Difficulty concentrating
  • Confusion
  • Tremors
  • Seizures
  • Hallucinations
  • High blood pressure

Cocaine Hangover

Alcohol hangovers are primarily characterized by a headache and feeling unwell. A cocaine hangover, commonly known as a cocaine comedown, is characterized by intense fatigue. Cocaine overstimulates your body, giving you abnormally increased energy. When its effects are gone, it leaves you feeling very tired because you have spent a lot of extra energy and no longer feel the additional stimulation. Someone coming down from cocaine may sleep for many hours or even a day or more.

Cocaine Comedown and Alcohol Withdrawal

Coming down from cocaine and withdrawing from alcohol are almost polar opposites. Cocaine is a stimulant that leads to tiredness and fatigue once its effects are gone. Alcohol is a depressant; while withdrawing from alcohol, the body becomes overstimulated until the brain and body fully adjust and withdrawal ends. 

The effects of a cocaine comedown and alcohol withdrawal make it particularly dangerous to use one substance while withdrawing from the other. If you are coming down off of cocaine, using alcohol will make you even more tired and exhausted. Using cocaine while withdrawing from alcohol is extremely dangerous, as it can lead to overstimulation and stress on the body that could be deadly.

Why Do People Use Alcohol and Cocaine Together?

People use alcohol and cocaine together for many different reasons. Some people do it just to see what will happen. Others combine these two substances to help even out the effects that each substance will have, not realizing that this increases the risk of overdose on both substances and the risk of toxicity. 

Sometimes, people combine alcohol and cocaine to purposely create cocaethylene. This substance is very dangerous, but it is essentially a long-lasting form of cocaine. While it is dangerous to intentionally create cocaethylene, some people chasing a better high will do so to feed their cocaine addiction.

Get Help for Cocaine and Alcohol Addiction in Columbus, OH

Due to the dangers associated with mixing cocaine and alcohol, it is essential to seek professional alcohol and cocaine addiction treatment promptly. Addiction can cause someone to use substances in a harmful way, even though they are aware of the potential risks. Recognizing the signs of cocaine and alcohol abuse in loved ones is a critical step in helping them seek treatment and recovery.

Signs of cocaine and alcohol abuse include:

  • Being unable to limit or stop cocaine or alcohol use
  • Experiencing intense cravings to use cocaine or alcohol
  • Suffering from interpersonal problems due to cocaine or alcohol use
  • Disregarding responsibilities at home, work or school
  • Experiencing legal or financial issues as a result of cocaine or alcohol use
  • Developing a physical tolerance to cocaine or alcohol, resulting in higher quantities needed to feel the same effects
  • Experiencing withdrawal symptoms when cocaine or alcohol use is reduced or stopped

Due to the potential severity of cocaethylene detox, individuals seeking treatment for alcohol and cocaine addiction should utilize a professional medical detox program in which trained medical staff monitor and treat withdrawal symptoms. Treatment for cocaine and alcohol addiction may include residential or outpatient rehab, psychotherapy, support groups and medication-assisted treatment. Individuals often require a personalized treatment plan to help them recover from both cocaine and alcohol addiction.

If you’re struggling with addiction to cocaine and alcohol, The Recovery Village Columbus can help. Contact us today to speak with a representative and learn more about cocaine and alcohol addiction treatment programs that can work well for you. 

View Sources

Jones, A.W. “Forensic Drug Profile: Cocaethylene.” Journal of Analytical Toxicology, February 23, 2019. Accessed August 11, 2022.

National Institute on Drug Abuse. “Cocaine.” April 2021. Accessed August 11, 2022.

Dial, Jackie. “The interaction of alcohol and cocaine: A review.” Psychonomic Society, Inc., 1992. Accessed August 11, 2022.

U.S. National Library of Medicine. “Cocaine.” MedlinePlus, April 21, 2016. Accessed August 11, 2022.

Farooq, Muhammad U.; Bhatt, Archit; Patel, Mehul B. “Neurotoxic and cardiotoxic effects of cocaine and ethanol.” Journal of Medical Toxicology, September 2009. Accessed August 11, 2022.

Zipes, Douglas P. “Cardiomyopathies Induced by Drugs or Toxins.” Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 2019. Accessed August 11, 2022.

Andrews, Paul. “Cocaethylene Toxicity.” Journal of Addictive Diseases, October 17, 2008. Accessed August 11, 2022.


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