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  • Writer's pictureKim May

Why alcohol and cocaine just don’t mix

Updated: Mar 11, 2021

Dangers of cocaine and alcohol

Many people feel that the best way to use cocaine is to use it with alcohol. People like the perceived counterbalance they feel occur when the two are taken together.

Coke gotten you too jittery? Well, then have a drink. Alcohol making you too tired? Well, then do a line.

Studies estimate approximately 75% of cocaine users regularly consume alcohol while using. It is a not-so-secret secret that usually the easiest places to score coke are the places where the alcohol flows. The rationale being that these drugs go together, like peanut butter and chocolate.

Unfortunately, they do not really go together. Less like chocolate and peanut butter and more like bleach and ammonia—both useful (according to many) and potentially hazardous individually, but when combined, produce an incredibly dangerous combination.

Why people like to combine cocaine and alcohol

Alcohol is a central nervous system depressant, though initially we often feel a surge of energy and sociability. This is due to the biphasic nature of alcohol. With alcohol there is always a point of diminishing return, and this is typically when the depressant side effects kick in.

Cocaine is a stimulant. It produces feelings of euphoria and increases energy. So, when we start to lag from our alcohol consumption, adding cocaine to the mix brings us back up. However, too much cocaine can have unpleasant effects too. Drinking alcohol will “bring down” the cocaine high.

Since cocaine is reversing the sedating effects of the alcohol, users will end up drinking more than they might have. Since the alcohol is offsetting the unpleasant cocaine effects, more cocaine is often consumed. This creates a cycle of alcohol, cocaine, alcohol, cocaine.

Cocaine + Alcohol = Cocaethylene

Different drugs cause us to feel different ways and this is largely due to the way drugs are broken down in our bodies into chemicals or metabolites. Over time those metabolites are further broken down, leading to the effect of the drug wearing off.

However, when cocaine and alcohol are mixed, they form a new substance called cocaethylene and it is toxic. Cocaine is already hard on our bodies, increasing our heart rate and blood pressure, amongst other problematic effects. Cocaethylene is more cardiotoxic than cocaine alone, further increasing the risk of heart attack.

Some studies report the risk of heart attack goes up by 25% when alcohol and cocaine are taken together, versus when cocaine is taken by itself. Test subjects in research have shown “heartbeat was significantly faster in the ethanol and cocaine arm of the study”, as opposed to cocaine alone.

Interestingly, part of what makes the cocaine and alcohol combo appealing is what makes it so dangerous. An effect of cocaethylene is that it can make you feel sober. This is what allows us to end up consuming far more cocaine and alcohol than we might normally. Continued alcohol consumption causes cocaethylene to pass into the blood stream which can harm organs and tissues.

Cocaethylene and severe effects

Scott Weiland, of Stone Temple Pilots and Velvet Revolver fame died in 2015 from an overdose of alcohol, cocaine, and MDA. Tommy Hanson, a former Atlanta Braves pitcher was just 29 when he died in 2015 from the effects of alcohol and cocaine.

What is especially unfortunate about the aftermath of these deaths was how the media did not use this as an opportunity to educate us about the potential dangers of alcohol and cocaine when used together. These dangers may include:

· overdose

· stroke

· bleeding in the brain

· heart attack

· irregular heartbeat

· heart damage

· liver damage

· organ failure

· increased risk of suicide attempt

· sudden death from cocaethylene toxicity

Cocaethylene also blocks the reabsorption of dopamine in the brain. This results in a production of higher euphoric effects for both cocaine and alcohol. In turn this can produce a vicious cycle of taking more of each drug. A person is also more likely to engage in risky and violent behavior under these circumstances.

In addition to the medical issues, studies have found that individuals dependent on both alcohol and cocaine experience more accidental injuries, violence, and overdose than those who are dependent on cocaine alone.

The “Miami Vice Metabolite”

In a 1990 journal article in SCIENCE titled the Miami Vice Metabolite, Marcia Barinaga wrote about how the dangerous effects of cocaethylene were just being recognized. However, it's 30 years later and most us still have never heard of cocaethylene and are clueless about the dangers of combining alcohol and cocaine.

In 2019 a journal article from Journal of Analytical Toxicology, was written by a forensic toxicologist about cocaethylene. The writer stated his motivation for writing the article was due to a lack of peer reviewed scientific information about cocaethylene…still…in 2019.

Just Say Know

In her writings about harm reduction psychotherapy, Patt Denning frequently says, “Just say know to drugs”. Regarding drugs, Denning says to:

1. Know what they are

2. Know how they work

3. Know what you want

4. Know your limits

So, now you know about the dangers of cocaine and alcohol. Maybe you will still use them both together, but you will work on a safety/buddy plan. Maybe you will use them both, but no longer at the same time. Or maybe you need support to change or stop your use. If you do, Substance Use Therapy is here for you.


Denning, P., & Little, J. (2017). Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. The Guilford Press.

About the Author:

Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples, and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, gambling, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.

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