Cocaine (benzoylmethylecgonine) is a powerful central nervous system stimulant drug. The major mechanism of action associated with cocaine and other stimulants is to significantly increase the availability of neurotransmitters like glutamate, norepinephrine, and dopamine. The use of cocaine results in numerous stimulant effects, including increased heart rate, blood pressure, body temperature, and respiration. Additional effects include rapid thoughts, rapid speech, feelings of euphoria and wellbeing, etc.
Although cocaine is commonly characterized as a significant drug of abuse, it does retain some medical uses and therefore is classified by the United States Drug Enforcement Administration (DEA) in the Schedule II class of controlled substances. Cocaine is typically not prescribed to individuals but used in medical settings, such as an anesthetic for dental or nasal surgery (in rare situations). It cannot be legally obtained by private individuals, and the majority of its use is illicit.
Alcohol is a central nervous system depressant drug. Its effects are in direct opposition to stimulants like cocaine. The mechanism of action associated with alcohol use results in an inhibition of excitatory neurotransmitters (NDMA: N-methyl-D-aspirate, a form of glutamate) and greater availability of inhibitory neurotransmitters such as gamma-aminobutyric acid (GABA).
Alcohol is a significant drug of abuse, but it is legally available in many different forms. It ranks as the second highest used and abused drug in the United States behind tobacco products according to information provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). Alcohol is also one of the most common drugs of abuse for individuals who have polysubstance abuse issues (abusing more than one drug at a time). Alcohol is commonly abused with other central nervous system depressants, central nervous system stimulants, hallucinogenic drugs, cannabis products, etc.
Mixing Alcohol and Cocaine
In general, research studies have consistently reported that people who have a formal diagnosis of an alcohol use disorder (someone with an alcohol abuse issue or addiction to alcohol) very commonly also use stimulant medications. Often, alcohol is used to negate or “cut” the effects of the stimulant, such as cocaine. It is also used so the individual can take more of the stimulant without experiencing some of the detrimental effects associated with using it in large amounts (e.g., jitteriness, problems with attention, psychosis, etc.) while still experiencing the euphoria and other desired effects of the stimulant.
- The deadening of the effects of the stimulant drugs such that the individual may use more cocaine than they normally would use, leading to an increased potential for overdose
- The deadening of the effects of alcohol because of the effects of the stimulant, which can lead to an individual consuming more alcohol than they normally would and increase the risk for toxic effects or overdose on alcohol
- A significantly increased burden on the liver that can lead to significant liver damage over time (The liver metabolizes alcohol first, and then other substances. Liver damage is a common effect of alcohol abuse.)
- An increased potential for other organ damage, including issues with the gastrointestinal system (e.g. increased potential for ulcers), the cardiovascular system (e.g., increased potential for cardiovascular disease or heart attack), and increased potential to damage the kidneys (renal failure or kidney disease)
- Increased potential for neurological damage, including damage to the brain, the development of seizures, and increased potential for stroke, etc.
- Immediate issues with motor coordination that can result in the increased potential for a person to become involved in accidents
- Significant cognitive effects that include issues with attention, concentration, the ability to remember information, and significant problems with rational thinking and judgment that can also lead to risky behaviors
- Increased potential to develop numerous forms of cancer
- Dysfunctions with the immune system, leading to an increased risk for the development of disease
- Significant respiratory issues
- Increased risk to be diagnosed with a mental health disorder, such as a psychotic disorder, an anxiety disorder, major depressive disorder, bipolar disorder, etc.
- Increased risk to develop physical dependence on one or both drugs (significant issues with tolerance and withdrawal)
- Increased risk to develop a polysubstance use disorder (e.g., a co-occurring alcohol use disorder and stimulant use disorder)
The above dangers are associated with the use of alcohol and cocaine, and they represent the effects of combining alcohol with any central nervous system stimulant drug. In addition to these risks, there is an added risk that occurs due to the liver attempting to metabolize both alcohol and cocaine. A toxic substance, cocaethylene (ethylbenzoylecgonine) is produced when alcohol and cocaine are combined.
The book The Neurochemistry of Abused Drugsreports that the combined use of alcohol and cocaine leads to the production of a very toxic substance in the liver: cocaethylene. Approximately one-fifth of the cocaine in the system is disrupted during the liver’s attempt to metabolize it in conjunction with alcohol. Continuing to drink alcohol leads to the cocaethylene being released back into the system where it can affect other organs.
Cocaethylene is a waste product, and it is significantly more toxic than the products that produces it (cocaine and alcohol). It has been estimated that cocaethylene has a toxicity level that is nearly 30 percent greater than the toxicity level of cocaine. Once it starts being produced, it remains in the system three times longer than cocaine does, and its presence in the system significantly increases the risk for toxic events compared to using cocaine or alcohol alone.
Because the substance is far more toxic than many other waste products, it can result in significantly more damaging effects, such as:
- Increase in the potential to experience heart attack or stroke
- Increase in the potential to develop liver damage due to its longer half-life and tendency to remain in the system longer
- Increase in bingeing due to decreased reuptake of dopamine
- Increased potential to develop seizures due to the increase in excitatory neurotransmitters in the system
- Increased potential to experience negative effects to cognition as a result of all these effects, leading to greater impulsivity, poor decision-making, etc.
- Increased risk of developing other issues, such as being more susceptible to disease, cancer, etc., because of the presence of cocaethylene in the system
- Increased risk of developing psychosis
Moreover, sources like the National Institute on Drug Abuse (NIDA) report that the combination of cocaine and alcohol is associated with more fatalities than any other combination of two drugs. Individuals combining these substances are at a significantly higher risk for sudden death due to heart attack, stroke, or seizures, and due to lapses in judgment that can lead to accidents, suicidality, being the victim of crime, etc.
Moreover, the long-term effects of using cocaine and alcohol in conjunction can lead to other potential issues. One of the risks associated with chronic abuse of alcohol is the development of an alcohol use disorder, which may include the development of physical dependence to alcohol. The withdrawal syndrome associated with discontinuing alcohol can be potentially fatal due to seizures or delirium tremens (a syndrome of confusion, psychosis, and seizures). Combining cocaine with alcohol on a regular basis can lead to an increased vulnerability to the detrimental effects associated with the withdrawal from alcohol as a result of compromised functioning with the cardiovascular system, liver, and brain. Because there is also an increased risk that an individual who chronically abuses cocaine and alcohol in conjunction will also be diagnosed with some other mental health disorder, the increased burden of having a co-occurring mental disorder along with a polysubstance use disorder can lead to significant complications in recovery.
Individuals who have chronically abused alcohol and cocaine require more intense treatment and special treatment considerations.
These individuals most likely initially require inpatient admission, particularly for the medical management of withdrawal symptoms (medical detox) and to ascertain and treat any other complications associated with the detrimental effects of abusing both of these drugs. The course of treatment for such individuals would be expected to be long-term, complicated, and marked by numerous emotional and physical complications that can increase the potential for relapse and other potentially dangerous situations, including issues with depression and mood swings.
Chronic issues with physical health and mental wellbeing could emerge years after one has discontinued these drugs due to the toxic effects of combining these drugs. As a result, individuals benefit from long-term medical management, therapy, peer support, and participation in an aftercare program that requires years of involvement.