Rehab 4 Addiction

The Dangers of Mixing Cocaine with Alcohol

Cocaine and alcohol have been prevalent in society for thousands of years.

Natives in the Andes Mountains used to chew on coca leaves, the origin of cocaine, to help them with the mountainous thin air.

Alcohol also has a historical notion, brewed originally from jar residue where fruit and vegetables were being fermented.

For both substances, the intentions were primarily that of utility and function, now the motivations stand in the realm of sociability.

We have now crossed the border from function to danger, as we have rapidly developed our own reasons for ingesting the two at the same time.

Cocaine boosts dopamine in the brain, a neurotransmitter that plays a crucial role in our abilities to feel pleasure.

As a result, cocaine increases energy and alertness, producing an upsurge in sensory experiences.

However, it also involves a rise in body temperature, heart and blood pressure and muscle rhythm problems[1].

Alcohol is commonly known as a depressant, used regularly to enhance sociability and enjoyment.

Alcohol affects your thinking patterns, slows reactions, changes behaviour and clouds simple judgements[2].

Excessive use can cause similar problems to the use of cocaine, with organ concerns such as liver inflammation and cancer being at the top of the list.

When the substances combine, they create cocaethylene[3], a powerful metabolite. ‘Cocaethylene’ is a highly toxic compound; formed by the collaboration of ethanol and cocaine, remaining in your body for a prolonged period.

The toxic co-use of substances can prolong the risk of strokes and heart issues from days to months.

The plasma half-life of this toxic compound is 3-5 times more than that of pure cocaine[4].

This means you are 18-25 times more likely to experience an immediate death than from cocaine alone[5].

PRO TIP: Learn about the cocaine rehab process.

Profile: Cocaethylene

Cocaethylene is formed in the liver, with a fundamentally similar structure to cocaine. It’s technically considered to be an isolated ‘drug’ itself, created independently in the body by co-use.

You don’t have to ingest cocaethylene to get a ‘high’ from it, you’ve generated it yourself as a by-product.

Regular alcohol intake can lead to cravings for cocaine; this makes it harder to withdraw from drugs, resulting in binge-drinking to prolong effects.

With added euphoria and the persistent effects of cocaine, don’t be fooled. Cocaethylene is highly poisonous, more so than cocaine or alcohol by itself.

Studies have indicated that it is 30% more toxic than cocaine, which is why it’s closely associated with sudden death[6].

There might be quality control over alcohol, but no such criteria is evident in the market of drugs.

This means that the ‘cocaine’ some people are purchasing can be cut with even more lethal substances such as drain cleaner, a cocktail you don’t want to consume.

For cocaine, it can take 5 to 30 minutes to feel the effects. If it’s smoked rather than snorted, the effects are almost instantaneous.

For alcohol, the average is 30 minutes to feel any side effects of the ethanol you have consumed, depending on tolerance and substance.

Cocaethylene takes longer to get out of your system.

This puts stress on your body for a prolonged period of time, which can be fatal even up to 12 hours after you’ve taken both cocaine and alcohol.

Combining Stimulants and Depressants

Combining a depressant with a stimulant ensures competition between the two in the body. Alcohol is slowing down your brain and nervous system, and cocaine is trying to speed it all up.

Therefore, if you mixed alcohol with heroin, another depressant, you risk shutting down your organs and nervous system entirely.

Cocaine can mask alcohol impairment, leading someone who is heavily intoxicated to believe they are sober[7].

This is a quick route to an overdose or alcohol poisoning, as using a stimulant with a depressant can amplify dangerous side effects such as suicidal thoughts or heart palpitations.

Many individuals use cocaine and alcohol simultaneously as they believe it will[8]:

  • Boost their high from cocaine
  • Prevent withdrawal symptoms
  • Curb other negative side effects

Cocaethylene does extend the duration of cocaine’s side effects, but feeling high for a longer period doesn’t ‘boost’ your high.

This remains in the body longer isolated uses of alcohol or cocaine, increasing the risk of damage to vital organs.

Total duration varies depending on the amount and type of consumption.

Average timespan to eradicate substances:

  • Urine – 36 hours
  • Blood – 2 days
  • Hair – 2 months +

PRO TIP: Learn how long cocaine stays in your system.

Cocaethylene Study

A study carried out in 1994 by Xu et al found that cocaethylene was a ‘more potent blocker of cardiac sodium channels than cocaine’[9].

A vivid explanation regarding the heart effects of cocaine.

Six volunteers snorted 2mg of cocaine and drank ethanol instantaneously.

The euphoria induced by the cocaine appeared more enhanced with prolonged effects, but their heart rates were dangerously high.

The study proved that the effects of co-use would be likely to lead to psychological and physiological dependence.

After the first encounter with cocaethylene, individuals exhibit ‘drug-seeking behaviour’ and are likely to relapse following abstinence.

The Consequences of Mixing: A Deadly By-Product

Short Term:

  • Sudden stroke
  • Nose bleeds
  • Violent behaviour
  • Paranoia
  • Very high body temperature
  • Blood clotting

Long Term:

  • Mental health issues such as anxiety
  • Seizures
  • Organ damage
  • Increased cravings leading to addiction
  • High cancer risk
  • Sudden death
  • Miscarriage, stillbirth and development delays for unborn babies.

Dependence on Substances: Signs and Impacts

Reactions to drug ‘come downs’ will depend on your method of extraction, such as ‘cold turkey’ or slow reduction of intake.

There will be a combination of physical and emotional symptoms.

The symptoms can worsen over an average of 3 days, and the milder symptoms may persist for weeks. Duration of withdrawal depends on the nature of your addiction.

Common withdrawal signs include:

Mental and Emotional Symptoms:

  • Irritation and ‘brain fog’
  • Poor sleep and lack of energy/focus
  • Hallucinations
  • Anxiety and paranoia
  • Depression
  • Memory loss
  • Nightmares

Physical Symptoms:

  • Excessive sweating and fever/chills
  • High blood pressure
  • Fast respirations
  • Headaches and nausea
  • Violent shaking
  • Muscle and bone pain

Addressing Consumption

There are multiple recovery options:

Moderation or abstinence from Cocaethylene can be an option if you’re regularly mixing cocaine with more than 10-14 units a week.

If your consumption is higher than this, you may experience withdrawal, and require a GP appointment with medication to ease symptoms.

Withdrawals are at their worst in the first 48 hours, taking up to 7 days for them to ease.

How YOU can help:

  • Drink approximately 3 litres of water or non-caffeinated drinks
  • Eat regular meals, even without an appetite
  • DO NOT DRIVE, even if you think it’s out of your system
  • Meditate or open up to close relatives or friends to ease mental stress.

Concluding Thoughts on Cocaethylene

Cocaethylene is a strong and toxic metabolite, formed in the liver when an individual ingests both alcohol and cocaine together.

The concentration limit and duration are difficult to predict, as it is dose and tolerance dependant.

Both ethanol and cocaine act as catalysts for euphoric highs, and many users use cocaine after alcohol to appear more ‘sober’ and prolong the effects of the drug.

The toxicity of cocaethylene is dramatically higher than alcohol or cocaine alone, and the concentration of the two together is a lethal mix.

The effects are highly deadly, affecting behaviour, mental health, and physical health.

Sudden death is no mystery when your liver creates this by-product, where poisoning and organ failure becomes highly likely.

Ingesting both simultaneously increases your risk of cocaine addiction[10], meaning long term risks start to outweigh short term benefits.

Whilst clouding how drunk you think you are, cocaine only masks intoxication, leading you to falsely believe you are still sober.

It will not prevent the side effects of a hangover or a ‘come down’ but increase your chances of having issues such as anxiety, depression, paranoia, and seizures.

Your risk of getting addicted after the first bout of cocaethylene is extremely high, so it’s better not to risk your chances.

If you think you are at risk of addiction, are at high risk of relapse, or simply want to know more, don’t hesitate to reach out and get help.




[3] Randall, T., 1992. Cocaine, alcohol mix in body to form even longer lasting, more lethal drug. Jama267(8), pp.1043-1044.

[4] Amitava Dasgupta, in Alcohol, Drugs, Genes and the Clinical Laboratory, 2017

[5] Andrews P. Cocaethylene toxicity. J Addict Dis. 1997;16(3):75-84. doi: 10.1300/J069v16n03_08. PMID: 9243342.

[6] Andrews P. (1997). Cocaethylene toxicity. Journal of addictive diseases, 16(3), 75–84.



[9] Xu, Y.Q., Crumb, W.J., Jr., Clarksom, C.W. (1994) Cocaethylene, a metabolite of cocaine and ethanol, is a potent blocker of cardiac sodium channels. The Journal of Pharmacology and Experimental Therapeutics, 271, 319–325.

[10] Brady, K.T., Sonne, S., Randall, C.L., Adinoff, B. and Malcolm, R., 1995. Features of cocaine dependence with concurrent alcohol abuse. Drug and Alcohol Dependence39(1), pp.69-71.

[11] Frances R. Frankenburg MD, Brain-Robbers: How Alcohol, Cocaine, Nicotine, and Opiates Have Changed Human History, 2014

[12] Lightowlers, C. and Sumnall, H., 2014. A violent mix? The association between concurrent alcohol and cocaine use and violence amongst young people in England and Wales. Drugs: Education, Prevention and Policy21(2), pp.131-139.

[13] Pakula, B., Macdonald, S., Stockwell, T. and Sharma, R., 2009. Simultaneous use of alcohol and cocaine: A qualitative investigation. Journal of Substance Use14(2), pp.101-112.


Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline.