Doctors have issued a warning about the “deadly combination” of cocaine and alcohol, after the BBC’s Victoria Derbyshire programme revealed there were at least 13 “self-inflicted” deaths linked to the drug combination in England in 2018.
Dr David Bremner, group medical director for Turning Point, which offers advice and support on substance misuse, tells HuffPost UK mixing the two substances “is very dangerous” and in some cases can prove deadly.
Last year, Mac Miller was found dead in his home and a coroner later determined he’d died from an accidental overdose due to a “mixed toxicity” of fentanyl, alcohol and cocaine.
Logan Woolliscroft, 21, died after falling off a cliff near his family’s Derbyshire home in 2018. His dad Steve told the Victoria Derbyshire show he found 8g of empty cocaine bags and a bottle of Disaronno at the top of the cliff and instantly knew his son was dead.
Logan’s body was later discovered and his dad believes the toxic mixture of cocaine and alcohol played a key part in his death. He had become increasingly volatile and depressed in the three months before his death, his dad said.
Mixing alcohol with cocaine is becoming increasingly “normalised” in society, says Dr Bremner, who believes awareness and education is the key to reducing harm caused by combining the two. “Very few people understand how dangerous the combination of alcohol and cocaine are,” he says.
So what exactly happens to your body (and mind) when you mix them?
First up, the scientific bit.
All drugs get broken down by the body into chemicals and metabolites, which then give us the effect of that particular drug, Dr Bremner explains. So when cocaine is broken down, for example, it breaks down into metabolites and you then feel the effect of those metabolites – the short-lived, intense high.
As the metabolites get broken down into more metabolites, you lose the effect of the cocaine and at this point people will likely want to take some more.
When you take cocaine and drink alcohol together, however, your metabolism changes and creates a very specific metabolite called cocaethylene.
“It’s a very active metabolite,” says Dr Bremner. “It makes your cocaine feel more effective. So the person taking the cocaine thinks ‘hell, this is good cocaine’, but actually what they’re experiencing is the effect of cocaine augmented by alcohol.”
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) suggests that over half of cocaine-dependent individuals also suffer from alcohol dependency, highlighting how the two are often interlinked.
Another effect of cocaethylene is that it lasts longer than the usual metabolites of cocaine, says Dr Bremner. So not only do people think they’re taking ‘better’ cocaine, but the high lasts much longer than the typical 20-minute experience,
The physical impact
Mixing cocaine and alcohol on a night out might seem like a good idea, but the impact it can have on your heart can be very serious indeed. “The downside of cocaethylene is that it’s very toxic,” warns Dr Bremner, “so while this metabolite is coursing through your veins, you are 25 times more likely to die of a heart attack than if you were just taking cocaine by itself.”
Cocaine and alcohol combined can raise your blood pressure and cause your heart to beat faster. Dr Rachel Britton, lead clinical pharmacist at Addaction, says cocaethylene is damaging to the heart and in severe instances can cause sudden death. It can also put a lot of stress on your liver.
While you might think that a heart attack won’t happen to you if you’re young, Dr Bremner offers a word of caution: “The tragedy is once you’ve had a heart attack you’ve damaged your heart. The diseases that we are prone to are invited into the body a hell of a lot earlier and not picked up because nobody’s inspecting it.”
Cocaethylene also has the ability to make you feel sober – which might seem a positive but can backfire. “You might be out at a bar, you’ve had six pints, and normally without the use of cocaine you’d be slurring your words and needing to sit down, realising it’s time to go home,” says Dr Bremner. “The difficulty with the cocaethylene is that it stimulates you to a point that it almost cancels out your alcohol intoxication or the drowsiness and suppressive effects of the alcohol.”
So you’re able to drink more than normal and but enter a vicious cycle where you sober up, take more cocaine, the coke wears off, the drunkenness kicks in, you take more coke, the coke stimulates you, you drink some more. And so on.
When the cocaine does eventually run out, the alcohol can catch up with people with the ferocity of a steam train. This can prove dangerous and can mean people are particularly vulnerable on their way home from nights out.
The mental impact
Mentally, alcohol and cocaine prove “a really dangerous” mix because while alcohol reduces inhibitions and impacts your ability to make wise decisions, cocaine causes momentary euphoria and quite often feelings of invincibility, says Dr Britton. “You can understand why people might harm themselves unintentionally,” she says, alluding to the Victoria Derbyshire findings.
A study by Brown University found that combining alcohol and cocaine increased the risk of suicide. Dr Bremner says “taking cocaine with alcohol removes the safe place” – so people might be more likely to cause harm to themselves.
He suggests this is because when they take cocaine and alcohol together, people can act on whatever emotion they’re experiencing, rather than passing out or feeling sleepy from the booze. “Instead they’re having incredible mood swings, they’re very disinhibited from alcohol, and they’re able to do something about it,” he says. “It is very dangerous.”
The combination of alcohol and cocaine has a very serious effect on serotonin reuptake in the brain. Expanding on this, Dr Bremner says: “Cocaine gives you an immediate sense of wellbeing and confidence but it’s very short-lived.”
In short, it releases “all of that day’s happiness in one burst”, leaving you with one euphoric burst followed by a “dramatic come down,” he says. “You can have amazing peaks and troughs – and of course alcohol does that as well.”
The combination can prove even more problematic for people who are already struggling with mental health issues. So if you’re feeling depressed anyway, the mixture of cocaine and alcohol can exacerbate your mood. Dr Bremner also worries that people with existing mental health issues might fall into the trap of self-medicating with cocaine and alcohol. “People who self-medicate very often make themselves feel incredibly worse,” he adds.
Long-term use of cocaine and alcohol is “really quite damaging” to your mental health, says Dr Britton. Users can end up feeling depressed or anxious, which might lead to feelings they want to end their lives or hurt themselves. “We know about the dangers of cocaine and we know about the dangers of alcohol,” she continues. “But what’s less described is the dangers of both.”
She urges people not to combine the two, and if you do plan to do so, not to do so alone – always make sure you’ve got someone there to watch out for you.
“We often find that people think they have to reach rock bottom before they can get help,” says Dr Britton. “But that isn’t the case.” For those who need help, Addaction runs an anonymous web chat and walk-in support services.
Need friendly, confidential advice on drugs or alcohol?
- Contact FRANK on 0300 123 6600 or visit the website for alternative contact methods.
- If you need help with a drinking problem, call the Alcoholics Anonymous national helpline for free on 0800 9177 650 or email help@aamail.org.
- For advice on how to reduce drinking, visit Drinkaware’s website or Alcohol Change UK.
- Find alcohol addiction services near you using this NHS tool.