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Mixing Cocaine and Alcohol: Effects, Dangers, and Long-Term Risks

Cocaine is a highly addictive stimulant drug and alcohol is a depressant.1, 2 People often use cocaine with alcohol for recreational purposes, but they may not be aware of the consequences.3 Combining cocaine and alcohol is dangerous and can lead to a variety of short- and long-term health risks, including increasing a person’s risk of overdose and the formation of a toxic substance known as cocaethylene.2, 4

Why People Mix Cocaine and Alcohol

Using 2 or more substances at the same time is known as polysubstance use (sometimes referred to as concurrent substance use, co-occurring substance use, simultaneous substance use, and polydrug use).2, 5

Polysubstance use can be intentional, meaning a person purposely uses 2 or more substances together for a specific reason. It can also be unintentional, such as using substances that have been cut, laced, or mixed without their knowledge.2, 5

People use cocaine and alcohol together for different reasons. They might want to alter or enhance their high, party for longer, mitigate feelings of alcohol-related inebriation, or reduce feelings of the high caused by cocaine.3, 5 They may also mix substances to escape from certain life circumstances such as stress or trauma, or to prevent withdrawal symptoms.5

The Short-Term Effects of Mixing Cocaine and Alcohol

Cocaine is a powerful stimulant drug that works by increasing levels of dopamine, the body’s natural reward chemical that also plays a role in movement.1 Dopamine is a strong reinforcer, which means that it causes a person to want to repeat pleasurable activities (like using cocaine).1 This can fuel the cycle of addiction because a person might continue using cocaine when the effects wear off so they can maintain feelings of pleasure and avoid withdrawal symptoms.1

Short-term effects of cocaine may include:1

  • Increased energy and happiness.
  • Increased alertness.
  • Irritability.
  • Paranoia.
  • Hypersensitivity to light, sound, or touch.
  • Bizarre and unpredictable behavior (when cocaine is consumed in large amounts).

Alcohol is a depressant that can impact a person’s behavior, coordination, mood, and thinking.6 Blood alcohol concentration (BAC) and alcohol tolerance, among other factors, can influence the short-term effects a person experiences when they drink alcohol.7 As a person’s BAC rises, some short-term effects may include: 7

  • Drowsiness.
  • Impaired coordination
  • Impaired judgment.
  • Decreased alertness.
  • Decreased blood pressure and body temperature.
  • Nausea and vomiting.
  • Coma.
  • Death.

Cocaine and alcohol can have several adverse health effects when used separately. When used together, the 2 substances can have even more dangerous and unpredictable effects.2, 3

Many people mistakenly think that cocaine and alcohol “cancel” each other out when used together; however, studies show that each substance can compound their ability to cause different physical and psychological problems.3 Evidence also suggests that the enhanced psychological effects a person experiences from using cocaine and alcohol together may encourage them to consume more of each substance over time.8 This can increase a person’s risk for greater toxicity than when using each drug separately.8

Mixing cocaine and alcohol can affect blood pressure and heart rate, which increases a person’s chance of experiencing cardiovascular toxicity (damage to the blood vessels or heart).9, 10

Both cocaine and alcohol use by themselves can lead to overdose, which can be fatal.1, 11 When cocaine and alcohol are combined, the risk of overdose is greater.2

Mixing cocaine and alcohol can increase a person’s risk of injuring themselves or others around them. Cocaine can antagonize (or block) the effects of alcohol, and a person might feel like they are fine to drive or perform certain tasks when they really aren’t.3, 12 Studies also suggest that combining cocaine and alcohol can increase the risk of violent thoughts and threats, which can lead to increased violent behaviors.3

Cocaethylene

Using cocaine and alcohol together can lead to the formation of cocaethylene, which can pose many dangers and health risks.4

Cocaethylene is a highly toxic substance metabolized by the liver when a person consumes cocaine and alcohol together.13 Cocaine use alone is associated with a high risk of liver fibrosis, but using alcohol increases this risk due to the production of cocaethylene, which is more toxic than either substance on its own.13, 14

Cocaethylene is believed to be more toxic for the heart as well and can result in a risk of hypertension, increased heartbeat, and elevated body temperature.14

The Long-Term Effects of Mixing Alcohol and Cocaine

Using cocaine and drinking alcohol separately can cause several long-term health effects. Together, the effects may be compounded.

Cocaine can lead to several long-term health effects, which vary depending on the method of administration:15

  • Loss of smell, nosebleeds, hoarseness, and problems swallowing (if snorted).
  • Worsened asthma and lung damage (if smoked).
  • Increased risk of hepatitis C and HIV (if injected).
  • Gastrointestinal tears and ulcerations.
  • Loss of appetite loss, leading to malnutrition and weight loss.
  • Chest pain and inflammation of heart muscle.
  • Increased risk of seizures and stroke.
  • Bleeding in the brain.
  • Irritability and restlessness.
  • Anxiety, panic attacks, paranoia, or psychosis.
  • Increased risk of Parkinson’s disease or other movement disorders (with long-term use).
  • Impaired cognitive abilities (with long-term use).

Chronic alcohol use can also cause many physical and psychological harms. As with cocaine, alcohol can damage several organs. Long-term effects of alcohol include:16

  • High blood pressure.
  • Cardiovascular disease
  • Risk of stroke.
  • Liver disease.
  • Digestive problems.
  • Increased risk of breast, liver, colon, rectal, esophagus, mouth, throat, and voice box cancer.
  • Impaired immunity.
  • Learning or memory problems, including dementia.
  • Anxiety, depression, or other mental health problems.

Chronic use of cocaine or alcohol can lead to addiction, known as a substance use disorder (SUD), which is a chronic but treatable medical condition characterized by continued, compulsive substance use despite its negative consequences.1, 16, 17

The impact of a single SUD can be significant and far-reaching and include several physical and psychological consequences.18 The consequences can be even greater for a person who has a polysubstance use disorder and can include higher rates of arrests, legal issues, suicide attempts, and more severe co-occurring disorders.5

Getting Help

Mixing stimulants and depressants is dangerous because they can have unpredictable and potentially lethal effects.2 If you suspect that you or someone you care about has a problem with cocaine or alcohol use, you should know that help is available. No matter how bad things might seem, addiction is a treatable disease.18

Treatment for co-occurring disorders is available for people struggling with polysubstance use or mental health conditions that may also be present. American Addiction Centers (AAC) is a leading provider of cocaine rehab, and alcohol addiction treatment with facilities across the U.S. If you’re ready to reach out, we’re here to help. You can call our free, confidential helpline at for more information about rehab, and easily verify your insurance online.

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