Cocaine is a highly addictive stimulant drug made from the leaves of South American coca plants.1 As a street drug, cocaine comes in the form of fine, white, crystal powder.1 People who abuse cocaine may also mix it with alcohol to alter its subjective effects and lessen the stimulant crash once the high begins to wear off.2 Using these two substances together can be extremely dangerous and potentially life-threatening since combining the two raises the risk of polysubstance overdose or can present other dangers to your health and well-being.
What is Cocaine?
Cocaine may be encountered as a white powder or as a crystalline rock, known as crack. People commonly ingest cocaine by snorting, smoking, or injecting it into their veins or muscles, or rubbing it into their gums.3
It is also highly addictive, largely due to its rewarding effects on the central nervous system. Like many other illicit drugs, cocaine temporarily increases the activity of dopamine, the body’s natural reward chemical, which results in a high, or feelings of euphoria.4,5 The effects of cocaine appear almost immediately and can last for up to an hour, depending on the method of ingestion.6 Injecting or smoking cocaine may produce a more rapid onset yet shorter duration high than snorting.6
As a comparison, the high from snorting can last 15 to 30 minutes, while the high from smoking can last 5 to 10 minutes.6 Because of how short the high lasts, many people will continue using it more and more to continue their high.5 Although the euphoria doesn’t last long, cocaine doesn’t leave your system once the high goes away. A urine test can detect cocaine in your system as long as 2 to 3 days after use, but for heavy users, it can be detected up to 2 weeks later.7
According to the 2018 National Survey on Drug Use and Health (NSDUH), 14.7% of the US population aged 12 and over reported to cocaine use at some point in their lifetime, while 2% said they had used in the past month.1 Globally, the World Health Organization reports that “prevalence rates for lifetime use of cocaine are typically 1-3% in developed countries,” with populations in the United States and the producer countries having higher rates of use.8
Short & Long-Term Effects of Cocaine Use
Cocaine’s short- and long-term effects can vary from person to person, depending on individual physiology, as well as dose and frequency of use. Generally speaking, the short-term effects of cocaine use can include:9,10
- Physiological effects such as dilated pupils, constricted blood vessels, and increased body temperature and heart rate.
- Psychological effects such as euphoria, paranoia, psychosis, restlessness, irritability, panic, and anxiety.
- Increased risk of heart attack, stroke or coma; and gastrointestinal issues, such as abdominal pain or nausea.
- Increased risk of violent or harmful behavior, including homicide and suicide.
- Cocaine-induced delirium, which may include confusion and autonomic nervous system instability (e.g., unstable blood pressure, pulse changes, and sweating).
- Sudden death due to cardiac arrest or seizures in rare cases.
The long-term effects of cocaine use may include:11
- Building a tolerance (i.e., needing higher doses to achieve previous effects).
- Loss of smell, nosebleeds, problems swallowing, hoarseness, and a chronically runny nose in people who snort it.
- Lung damage or asthma in people who smoke it.
- Puncture marks and risk of infectious diseases like hepatitis C or HIV in people who inject it.
- Damage to the gastrointestinal, cardiovascular, and respiratory systems.
- Increased risk of heart attack or stroke.
- Intracerebral hemorrhage, or bleeding in the brain.
- Increased risk for Parkinson’s disease (usually after many years of abuse).
- Cognitive problems, such as poor memory and problems paying attention.
Signs and Symptoms of Cocaine Addiction
Not everyone who uses cocaine will become addicted. Addiction develops as a person loses control over many, if not all, aspects of their lives to use the drug; they continue to use despite knowing the negative consequences of their drug use.12
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person who has a cocaine addiction is diagnosed as having a stimulant use disorder.13 At least 2 of the following criteria must be met within a 12-month period to receive this diagnosis: 13
- Taking cocaine in higher amounts or more frequent doses than originally intended.
- Being unable to cut down cocaine use.
- Spending a lot of time obtaining, using, and recovering from the effect of cocaine.
- Cravings, or strong urges to use.
- Failing to fulfill major obligations at work, home, or school due to cocaine use.
- Continuing cocaine use despite having persistent or recurring interpersonal or social problems due to substance use.
- Giving up important recreational, social, or work activities because of cocaine use.
- Using cocaine in situations where it is physically dangerous to do so (e.g., driving).
- Continuing cocaine use despite knowing that you have a physical or psychological problem that is likely the result of cocaine use.
- Tolerance, meaning that you need higher amounts or more frequent doses of cocaine to achieve prior results.
- Withdrawal symptoms when you try to stop using, such as depression, agitation, or fatigue.
Note: When it comes to alcohol use disorders, a similar set of criteria is used to make a diagnosis.
What are the Effects of Mixing Alcohol & Cocaine?
According to the DSM-5, people who abuse cocaine often combine it with alcohol.13 When looking at substance-related emergency department visits, the combination of alcohol and cocaine has been historically common.14
Drinking alcohol can also intensify feelings of euphoria due to cocaine use, while simultaneously helping to ease the discomfort of “coming down” from the high.2 Unfortunately, users often don’t understand the deadly combination of the two substances and the life-threatening effects it can have. Alcohol can also increase the desire to use cocaine, with one study finding that alcohol use increases cravings in current users and may be associated with increased relapse rates in those trying to quit.15
Other harmful effects of mixing alcohol and cocaine can include:16,17,18
- The risk of cocaine overdose can be increased by mixing it with alcohol.
- Intracranial hemorrhage (bleeding in the brain).
- Heart attack.
- Chronic cardiac toxicity.
- Cardiac arrhythmia.
Can I Stop Abusing Alcohol and Cocaine on my Own?
While stopping use of both alcohol and cocaine is in a person’s best interest, it can be dangerous to go through detox without the supervision of a medical professional. You may experience troublesome withdrawal symptoms such as depression and fatigue when you try to stop using cocaine.5 Though these may not seem severe on their own, abruptly quitting alcohol may result in an acute withdrawal syndrome that may be more severe or complicated when also stopping use of cocaine.
Symptoms of alcohol withdrawal, which can be severe and fatal in some instances, can include:19,20
- Mood swings.
- Sweating or clammy skin.
- Rapid heart rate.
- Chronic memory disorder.
- Sleep disturbances.
- Persistent alterations in mood and behavior even after acute withdrawal has ended.
- Delirium tremens, a serious complication that can lead to hallucinations, mental confusion, and disorientation.
Many who seek to stop using cocaine and alcohol choose to enter medical detox, which is an intervention designed to help you safely and comfortably eliminate both substances from your body. While medical detox services may be available on an outpatient basis, when the risks of withdrawal severity are relatively high, inpatient withdrawal management may be needed to keep a person as safe and comfortable as possible.
This type of detox provides 24/7 monitoring by a medical team who can administer medication, address co-occurring medical or psychiatric issues, and provide other types of support to help you through the entire withdrawal process so that you are better-prepared to enter a substance abuse treatment program.19
Treating Co-Occurring Alcohol and Cocaine Addiction
Effective addiction treatment may go beyond merely focusing on substance abuse to best address all of your needs. It recognizes that people are more than just the problems they present with and that they can suffer from multiple physical, psychological, social, vocational, and legal concerns. An individualized treatment plan should be assessed and changed regularly to meet your evolving needs as you progress through the treatment process.21
While there’s no one-size-fits-all approach to treatment, co-occurring substance use disorders are commonly treated through a combination of medication, behavioral therapy, and support groups that address the problem as a whole. Behavioral therapies—which include individual, family, and group therapy—are the most frequently used forms of drug treatment.19
In addition to medication and support groups, you may participate in a variety of therapies in treatment, such as:22
- Cognitive-behavioral therapy to address underlying feelings and thoughts that can lead to substance use or other negative behaviors.
- Motivational enhancement therapy to help strengthen your motivation and make positive life changes, including quitting drugs and alcohol.
- Marital and family counseling to help address relationship issues and increase family support.
- Brief interventions to assess your drinking patterns, potential risks, and set goals to help achieve changes.
No medications are currently approved by the FDA to treat cocaine use or withdrawal, although research is ongoing.23 Specific benzodiazepines are approved to manage acute alcohol withdrawal and minimize the risk of serious complications such as seizures. FDA approved medications for treating alcohol use disorder in the longer term and include: 21
- Naltrexone helps reduce heavy drinking.
- Acamprosate can help individuals abstain from alcohol use.
- Disulfiram, which causes unpleasant symptoms (such as nausea) if you do decide to drink, which can also motivate you to avoid drinking while taking the drug.
If you suspect that you or someone you care about has a cocaine and/or alcohol addiction, it may be time to seek professional help. Research has shown that rehabilitation treatment can be very effective in helping individuals maintain a life of sobriety.24
Depending on the type of program and your insurance coverage, the cost of a treatment program for alcoholism can vary widely. Because treatment costs can differ, you want to make sure the program you enroll yourself or your loved one in will actually work. American Addiction Centers (AAC) can improve treatment outcomes for those in recovery for alcohol use disorder. Find out if your insurance covers treatment at an AAC facility by filling out the form below.
. National Institute on Drug Abuse. Cocaine.
. Pennings, E., Leccese, A., & Wolff, F. (2002). Effects of concurrent use of alcohol and cocaine. Addiction, 97(7):773-83.
. Drug Enforcement Administration. (2019). Cocaine.
. MedlinePlus. (2019). Cocaine withdrawal.
. National Institute on Drug Abuse for Teens. (2019). Cocaine.
. National Institute on Drug Abuse. (2018). DrugFacts: Cocaine.
. University of Rochester Medical Center. Cocaine screen.
. World Health Organization. Cocaine.
. National Institute on Drug Abuse. (2016). Cocaine: What are the short-term effects of cocaine abuse?
. Morton W. A. (1999). Cocaine and psychiatric symptoms. Primary Care Companion to the Journal of Clinical Psychiatry, 1(4), 109–113.
. National Institute on Drug Abuse. (2016). What are the long-term effects of cocaine use?
. National Institute on Drug Abuse. (2018). The Science of Drug Use and Addiction: The Basics.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing; 562-567.
. Richard A. Lange, M.D.; L. David Hillis, M.D. (2001). Cardiovascular Complications of Cocaine Use. New England Journal of Medicine, Vol. 345(5), 351-358.
. Marks, K. R., Pike, E., Stoops, W. W., & Rush, C. R. (2015). Alcohol administration increases cocaine craving but not cocaine cue attentional bias. Alcoholism, Clinical and Experimental Research, 39(9), 1823–1831.
. Farooq, M. U., Bhatt, A., & Patel, M. (2009). Neurotoxic and cardiotoxic effects of cocaine and ethanol. Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology, 5(3), 134–138.
. Arias, S. A., Dumas, O., Sullivan, A. F., Boudreaux, E. D., Miller, I., & Camargo, C. A., Jr (2016). Substance use as a mediator of the association between demographics, suicide attempt history, and future suicide attempts in emergency department patients<. Crisis, 37(5), 385–391.
. Kaye, S. and Darke, S. (2003) Non-fatal cocaine overdose and other adverse events among injecting and non-injecting cocaine users. Sydney: National Drug and Alcohol Research Centre.
. MedlinePlus. (2019). Alcohol withdrawal.
. Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: pathophysiological insights. Alcohol Health and Research World, 22(1), 61–66.
. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment.
. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help.
. National Institute on Drug Abuse. (2016). Cocaine: How is cocaine addiction treated?
. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help.