Cocaine and Alcohol: Why the Combination Is So Risky

Why people combine cocaine and alcohol

People give many reasons for using the two together. Some say alcohol takes the edge off the jittery feeling of cocaine. Others say cocaine makes them feel less drunk, so they keep drinking longer.

That second effect is part of the danger. Feeling more alert does not mean the body is handling alcohol any better. It can lead people to drink far more than they realize.

What is cocaethylene?

When cocaine and alcohol are in the body at the same time, the liver produces cocaethylene. Research summarized by NIDA links it to stronger and longer-lasting effects on the heart than cocaine alone.

Concerns researchers have raised include:

• Heart strain: higher heart rate and blood pressure, which can raise the risk of heart problems.
• Longer effects: cocaethylene stays in the body longer than cocaine, so the strain can last for hours.
• Liver stress: the liver has to process both substances and their byproducts.
• Higher overdose risk: masked drunkenness can lead to taking more of either substance.

Other risks of mixing the two

Beyond the physical effects, the combination can affect judgment and behavior:

• Impaired decisions: people may drive, take risks or end up in unsafe situations.
• Mood changes: some people become irritable, anxious or aggressive.
• Hidden contaminants: street cocaine may contain fentanyl or other substances, which adds serious overdose risk.
• Harder comedowns: the crash afterward can bring low mood, poor sleep and strong cravings.

Over time, a pattern of using both can make each habit harder to change. Our cross addiction article explains how one substance can shape use of another.

Warning signs of an emergency

Call 911 right away if someone who has used cocaine and alcohol shows signs such as:

• Chest pain: pressure, tightness or pain in the chest, arm or jaw.
• Breathing trouble: slow, shallow or labored breathing.
• Seizures: shaking, stiffening or loss of awareness.
• Unresponsiveness: cannot be woken or will not respond.
• Overheating or confusion: very high body temperature, severe agitation or confusion.

Getting help for cocaine and alcohol use

If you or someone you love is using both, support is available and change is possible. Many treatment programs address more than one substance at the same time.

• Talk to a doctor: a health professional can review risks and discuss options.
• Explore treatment: outpatient, intensive outpatient and residential programs can all help. Read what IOP involves.
• Lean on others: peer groups and recovery coaches can offer steady encouragement.
• Involve family: loved ones can learn how to help without enabling.

SAMHSA's National Helpline at 1-800-662-4357 is free, confidential and open 24/7. FindTreatment.gov can help you find care near you, and our Resources page lists more options.

Frequently asked questions