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Mixing Cocaine and Alcohol

Written by Thomas Christiansen

& Medically Reviewed by Dr. Annie Tye, PhD

Medically Reviewed

Up to Date

This article was reviewed by a medical professional to guarantee the delivery of accurate and up-to- date information. View our research policy.

Last Updated - 6/17/2022

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Mixing cocaine and alcohol is popular recreationally, and approximately 75% of cocaine users surveyed in the United States in 2018 reported that they use alcohol in conjunction with cocaine. People who use cocaine and alcohol simultaneously do so for the prolonged euphoria that they experience. However, combining these drugs can have profound consequences on short- and long-term physical and mental health. Co-use of cocaine and alcohol is also associated with an increased risk of violence and death.

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Why Do People Mix Cocaine and Alcohol?

Co-consumption of cocaine and alcohol leads to a heightened and prolonged sense of euphoria compared to what either drug can provide on its own. In addition, many people report that co-use lets them “…stretch the good times.” Some people have the perception that cocaine can stave off the performance-impairing effects of alcohol and, while there is some evidence to support that belief, the negative consequences far outweigh the positive. Similarly, some people use alcohol to reduce the anxious, jittery cravings that are associated with “coming down” from their cocaine high.

Effects of Combining Alcohol and Cocaine

Concurrent use of cocaine and alcohol leads to pleasant, euphoric psychological experiences, including increased self-confidence, the perception of invincibility and decreased social anxiety. Many people choose to use cocaine while drinking alcohol to rescue them from the profound inebriation caused by large amounts of alcohol, leaving them with the misperception that they are less intoxicated than they actually are.

Unfortunately, these artificial states of wellbeing often potentiate further risky behavior such as additional drug use, unsafe sex and driving under the influence. In addition, several studies showed that concurrent cocaine and alcohol use increases the risk of violence, accidental death and suicide. The negative side effects of cocaine and alcohol co-use far outweigh the positive and can have lifelong physical, psychological and social ramifications.

Risks of Mixing Cocaine and Alcohol

There are a number of well-known physical risks associated with cocaine or alcohol use. When cocaine and alcohol are used in conjunction, these risks increase. Cocaine is a stimulant that is used for its ability to make people feel alert, energetic and confident. These effects are caused in part by cocaine’s ability to increase levels of excitatory neurotransmitters like dopamine and glutamate, leading to increased brain activity.

Alcohol is a depressant that is used for its ability to promote relaxation. Alcohol increases the signaling of an inhibitory neurotransmitter, GABA, which reduces brain activity. Several studies have found that concurrent use of cocaine and alcohol negatively affects intelligence, learning and memory. It may also potentiate further addiction.

Chronic, co-use of cocaine and alcohol can result in significantly increased impulsivity and attentional biases, as well as structural changes in the white matter of the brain. These changes support the theory that a cocaine and alcohol combination causes the brain to receive a significant amount of wear and tear as a result of chronic cocaine and alcohol use. The increased strain has been linked to impaired cognition and increased risk of early death.

Several studies provide data suggesting that one of the potential effects of mixing cocaine and alcohol is an increased risk of violence. A recent study that evaluated drug and alcohol presence in people who had completed suicide found that all of the decedents who tested positive for cocaine also had alcohol in their systems.


When cocaine or alcohol are used independently, the liver hydrolyzes them into metabolically inert chemicals that are excreted. However, when cocaine and alcohol are taken together, they interact in the liver to form a metabolically active product called cocaethylene. Studies show that cocaethylene has a half-life that is between three and five times longer than the half-life of cocaine, meaning that the profound physiological changes that occur after cocaine ingestion (increased heart rate, hyperthermia) persist for three to five times longer in the presence of cocaethylene. This aspect has been linked to an increased risk of heart attacks in otherwise healthy adults. Cocaethylene is currently the focus of a great deal of research, but all data indicates that it is significantly more toxic than either cocaine or alcohol on their own. Combining cocaine and alcohol significantly increases the risk of developing potentially fatal heart or liver problems and causes immune system dysfunction.

Like cocaine, cocaethylene is able to cross the blood-brain barrier, thus accessing the brain. Cocaethylene has similar effects in the brain as cocaine does, but because it accumulates at a rate of up to four times faster than cocaine and has a half-life of three to five times longer, it is far more potent and dangerous than cocaine alone. Once cocaethylene reaches the brain, the euphoric reward is substantially more powerful than that of cocaine alone, further reinforcing the addictive nature of cocaine.

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Treatment for Cocaine and Alcohol Addiction

Concurrent alcohol and cocaine addiction treatment is similar to treatment for a single substance use disorder, with the obvious exception that both drugs must be taken into account when planning and carrying out a rehab program. Many people who are struggling with cocaine and alcohol use disorders will benefit from a medically supervised detox, which is done under the supervision of medical professionals who can prescribe pharmacotherapies (often benzodiazepines to ease alcohol-related symptoms and naltrexone to attenuate drug cravings) to mitigate the uncomfortable symptoms of acute withdrawal.

If you or a loved one struggle with cocaine and alcohol use, contact The Recovery Village Ridgefield to speak with a representative about how professional addiction treatment can help. Under the supervision of medical professionals, clients at The Recovery Village Ridgefield can focus on addressing their addictions and any co-occurring mental health disorders. Take the first step toward a healthier future, call today.