What Is Cocaethylene, and How Dangerous It Is?

You’re out with friends, a few drinks in, and dancing the night away. At first you felt great, but now the euphoric alcohol effects are beginning to wear off. You’re starting to feel a little tired, ready for the night to end. But as you get ready to leave, someone offers you a “super easy” way to keep the night going and make it even better. Just a little cocaine: you’ll be feeling great and ready for the rest of the night!

Beyond the regular risks of cocaine use, what is the risk of mixing cocaine and alcohol? In this blog, we’ll explore what happens when we use alcohol, cocaine, and both of them together. Let’s dig into the dangers of mixing alcohol and cocaine and learn some tips for staying safe and gaining control of our substance use.

What Is Alcohol? 

The “alcohol” we consume in beer, wine, or other spirits is chemically known as “ethanol.” It’s produced during the fermentation process, where yeast breaks down sugar and produces ethanol as a by-product. Alcohol has psychoactive effects, meaning that it can change our brain function and affect our mood, thoughts, awareness, feelings, and movements.

Our first sips of alcohol may make us feel happy and more awake. For this reason, many people think of alcohol as a stimulant that “gets the party started.” However, alcohol is actually a depressant, meaning it slows things down in our brains. This effect takes longer to notice, but it always kicks in. Ever feel tired or foggy after a few drinks? That’s the depressant effect at work. As a depressant, alcohol can decrease our inhibitions and cause us to feel relaxed or sedated. 

How Does Alcohol Affect Us? 

There are both short- and long-term consequences of drinking alcohol. Let’s begin with a review of how alcohol can affect our body and mind in the short and long term. 

Short-Term Effects

In the short term, alcohol impacts our body, behavior, and mood. As a depressant, alcohol slows down our body and mind, and we might lose control of our impulses or motor function. This reduced functionality shows up throughout our body in different ways.

• Physical effects include impaired motor coordination, slurred speech, slowed reaction time, poor balance, dehydration, nausea, vomiting, or passing out.
• Behavioral changes may leave us feeling sociable, excited, or disinhibited. We may also start acting loud and boisterous or engage in risky decision making.
• Mood changes can swing rapidly from happy and elevated to sad and depressed to angry and aggressive.

Long-Term Effects

In the long term, alcohol can rewire the connections in our brain and cause chronic changes in our physical, mental, and social health.

• Physical symptoms of long-term alcohol use include a weakened immune system, liver damage, elevated blood pressure, irregular heart beat (arrhythmia), insomnia, brain damage, or gastrointestinal dysfunction.  
• Mental health suffers dramatically from long-term alcohol use. We may experience depression, anxiety, or memory problems, and we are at an increased risk for behavioral disorders like schizophrenia or psychosis.
• Social health can deteriorate as our behavior and mental health isolate us from healthy social circles. We may also find that the connections we make while intoxicated are not as strong or authentic without our “beer goggles.”

Chemical Effects

Neurotransmitters are a crucial element of our brain’s communication system. They trigger and regulate all of our thoughts and actions. There are two main neurotransmitters altered by alcohol — dopamine and gamma-aminobutyric acid (GABA).

Dopamine is known as the “reward” neurotransmitter, so a temporary increase in dopamine makes us feel euphoric. Have you ever achieved a goal and felt a rush of satisfaction and joy? You can thank dopamine for that! When alcohol dumps dopamine into our brain, we get a rush of energy and excitement that mimics a stimulant effect — that’s our brain telling us, “I want more!”

Despite this dopamine rush, alcohol mostly acts as a depressant, meaning it slows the nervous system down. GABA is our primary inhibitory neurotransmitter and is responsible for slowing down brain activity. Alcohol increases the effectiveness of GABA in our brain, which gives it more power to slow down various processes. This can result in slower thinking, poor coordination, or motor impairments.

What Is Cocaine?

Cocaine comes from the leaves of the coca plant, native to western South America. It was first used by the Inca Empire as a local anesthetic due to its numbing effects. In the late 19th century, chemists isolated the psychoactive component of coca (known as “cocaine”). It quickly left medical settings and became popular for recreational use. It was even a key ingredient in the original recipe for Coca-Cola!

As a stimulant, cocaine targets the reward system of the brain — specifically, dopamine — just as alcohol does. When we consume cocaine, dopamine floods our brain. Cocaine also blocks the process that recycles and clears the brain of excess dopamine. This surplus allows dopamine to communicate with more parts of the brain, amplifying the “reward” effect.

At the same time, cocaine increases the functionality of two stimulating neurotransmitters called epinephrine and norepinephrine, leading to a rise in heart rate and blood pressure. Just like alcohol used chronically, cocaine can stress out the heart and cause permanent damage or a decrease in functionality. 

What Does Cocaine Do?

Cocaine is highly addictive and known for its stimulating effects. Meanwhile, its harms and dangers are often overlooked. Let’s break down what cocaine actually does to us.

• Physical changes. Cocaine elevates blood pressure, increases body temperature, reduces appetite, increases heart rate, increases respiratory rates, and increases restlessness. 
• Mood changes. Cocaine induces feelings of happiness, euphoria, energy, awareness, sociability, and sensitivity to stimuli (touch, sound, and sight). 
• Behavioral changes. At first, cocaine can make us feel energetic, motivated, and focused, like everything in our brain is just moving faster. However, cocaine doesn’t discriminate between which parts of the brain it speeds up; it also increases risky or erratic behaviors such as violence, irritability, panic, insomnia, and paranoia. 
• Cocaine comedown. As the effects of cocaine wear off, we can experience symptoms such as anxiety, depression, irritability, headaches, exhaustion, body aches, sweating, and confusion. 

These effects can vary wildly depending on the person, the dose, and whether or not it is used in combination with other drugs. Because of this, it is widely considered to be dangerous and risky to use.

Legal and Safety Issues

It’s important to note that it is illegal to possess, sell, transport, and produce cocaine in most parts of the world (except for a few areas in South America). In the United States, cocaine is a Schedule II drug under the Controlled Substance Act, which means it has a high potential for abuse, although it does have legitimate medical uses as a local anesthetic for some eye, ear, and throat surgeries.

Recent reports indicate cocaine is increasingly being contaminated by fentanyl, an incredibly dangerous opioid that is lethal in very small amounts. Overdose deaths from fentanyl have increased fivefold in the last 20 years. Cocaine is one of the most common drugs mixed with fentanyl, and overdose deaths from this combination are 50 times higher than they were in 2010.

Unregulated drugs should never be trusted as they may contain fentanyl. In emergency situations, naloxone — an FDA-approved, over-the-counter overdose treatment medication — can be purchased by anyone. It is a safe antidote to a suspected overdose and, when given in time, can save a life. Many states and cities also distribute fentanyl test strips along with other addiction treatment resources. Anyone seeing signs of a fentanyl overdose should call emergency services immediately. 

Consuming Alcohol and Cocaine Together: Cocaethylene

It might seem that the effects of alcohol (a depressant) and cocaine (a stimulant) would cancel each other out. However, this isn't the case: the combination creates a more powerful and dangerous effect than either substance alone. When alcohol and cocaine are in the system at the same time, a by-product is produced in the liver called cocaethylene. Cocaethylene is a psychoactive agent that mimics the effects of cocaine but is longer lasting with more extreme symptoms.

How Does Cocaethylene Affect Us?

Cocaethylene is a by-product of concurrent alcohol and cocaine metabolism. The liver processes alcohol by breaking it down with specific enzymes. When these enzymes meet cocaine, they produce the by-product known as cocaethylene.

Cocaethylene amplifies and extends the effects of both alcohol and cocaine. Research indicates that it takes the body twice as long to metabolize cocaethylene compared to alcohol or cocaine alone, giving it longer-lasting effects.

• Physical effects. Mixing alcohol and cocaine can lead to extreme physical changes, such as increased body temperature, high blood pressure, slowed breathing, dehydration, loss of coordination, and elevated or irregular heart rate.
• Behavioral changes. Long- and short-term use of cocaethylene can decrease our inhibitions, inspire violent or aggressive behavior, and increase our risk of experiencing panic attacks, paranoia, or psychosis.
• Mood alterations. We may feel intense euphoria and happiness at first, then swing dramatically to feel anxious, depressed, or angry.
• Neurotransmitter changes. Cocaethylene increases levels of serotonin, norepinephrine, and dopamine by blocking the process that balances their levels. This imbalance is responsible for the extremity of cocaethylene’s effects.

The effects of cocaethylene are pretty dramatic — but how long do they last? And are they really as serious as they seem?

How Long Does Cocaethylene Stay In Our System? 

The “half-life” of a drug is the amount of time the body takes to reduce the substance by one-half. The half-life of cocaine is about one hour, but the effects of cocaine last for only 20 to 90 minutes depending on administration route.

Unfortunately, there is less research conducted on cocaethylene than on cocaine alone, but it is estimated the half-life is double that of cocaine — roughly 2 hours — resulting in longer-lasting effects. It’s important to note that the half-life of drugs are estimated averages and that there are individual differences in drug metabolism, such as weight, gender, overall health, diet, and genetics.

What Are the Dangers of Cocaethylene?

Because of the extreme changes cocaethylene induces, consuming alcohol and cocaine simultaneously is more dangerous than either substance on its own. The presence of cocaethylene in the system significantly increases the likelihood of sudden death — in fact, sudden death is 18 times more likely than when using cocaine alone.

Cocaethylene is particularly dangerous because it targets the following essential organs:

• The heart. Cocaethylene makes the heart work harder. Research has found that cocaethylene is 10 times more toxic to our heart than cocaine alone. This means that cocaethylene increases our risk of cardiovascular events that can lead to heart attack or stroke.

• The liver. Alcohol is notorious for causing liver damage, and mixing it with cocaine can create even more problems. Over time, toxins from cocaethylene build up in the liver and can lead to liver damage, disease, or failure.
• The brain. The competing neurological effects of alcohol as a depressant and cocaine as a stimulant can wreak havoc in the brain, leading to seizures, aneurysms, or swelling of the brain in severe cases.

How To Stop Cocaine and Alcohol Use?

Cocaine and alcohol are both highly addictive drugs. Treating alcohol or cocaine misuse can be challenging, and trying to stop them both at the same time is even more difficult. Luckily, there is hope! Research shows that if we use these substances together, long-term sobriety is more achievable if they are treated together.

Here are some of the best ways to stop the use of cocaethylene:

1. Detox. The first step to stopping use of alcohol and cocaine combined is to detox — let our body eliminate the substances. Before detoxing alcohol and cocaine, it’s important to understand the risks associated with each withdrawal process. Alcohol withdrawal can be dangerous and lead to fatal seizures. Stopping cocaine does not cause any inherent risks to life, but the withdrawal symptoms can be intensely unpleasant. Consulting with a healthcare professional and making a plan are essential steps. There are medications that can help, and doctors can prescribe them from the comfort of a televisit.
2. Therapy. After the detox phase, therapy can be an effective tool in the process of stopping use of cocaine and alcohol. Cognitive behavioral therapy is a research-based practice proven to help individuals overcome substance misuse. Other effective types of therapy include contingency management, motivational interviewing, or family therapy.
3. Groups. Quitting polysubstance use such as alcohol and cocaine can be achieved with peer support groups such as Alcohol Anonymous or Cocaine Anonymous. These support groups provide a group of peers working towards a common goal.

Quitting both alcohol and cocaine can be difficult, but there are ways to make the process easier. There is always hope, and there are many resources available to make the journey more manageable. A whole new life awaits in sobriety!