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  • What Is Cocaethylene? | Understanding The Byproduct Of Cocaine & Alcohol

    What Is Cocaethylene? | Dangers Of Mixing Cocaine & Alcohol

    Cocaethylene, also known as ethylbenzoylecgonine, is an active metabolite of cocaine formed in the liver when the illicit drug cocaine is consumed along with alcohol.

    This compound has a range of harmful effects on the human body and mind. This includes an increased risk of lasting physical harm or death in those who abuse both alcohol and cocaine at the same time.

    Cocaethylene Formation

    The liver, a large organ located inside the right upper quadrant of the abdominal cavity, is responsible for filtering the blood that comes from the digestive tract before it passes through the rest of the body. It breaks down toxins and metabolizes drugs with special enzymes so waste products can be expelled through the urine.

    Normally, the liver breaks down both cocaine and ethanol/alcohol at a steady rate as the substances enter the body. 

    However, if both of these substances are present, alcohol can interact with cocaine as it’s metabolized through a process called transesterification. This creates cocaethylene.

    It’s estimated that concurrent alcohol use and cocaine use can lead to 20% of the cocaine metabolized in the liver being converted to cocaethylene before it’s finally metabolized successfully. 

    And, the more alcohol is present, the more this new compound can escape the liver, pass into the bloodstream, and travel around the body

    Effects Of Cocaethylene 

    Cocaethylene has a range of physiological effects that can include:

    Excessive Intoxication

    Cocaethylene increases dopamine activity in the brain by interfering with dopamine transporter proteins and dopamine reuptake, meaning that the presence of cocaethylene can increase intoxication and euphoria when compared to use of alcohol or cocaine alone.

    For this reason, cocaine-infused wine became a popular beverage in the late 1800s in both France and the United States. 

    However, the heightened intoxication interferes with coordination, focus, judgment, and inhibition, increasing the likelihood that an individual will continue binging alcohol in the short-term and further increase cocaethylene formation.

    In the long-term, this severe intoxication increases the risk of continued, escalating, and harmful polydrug abuse.

    Increased Toxicity

    Research suggests that cocaethylene toxicity may be more than 30% higher than cocaine alone. The drug also has a longer half-life than cocaine, meaning that once it is present in the body it can last up to three times longer.

    Cardiovascular Effects

    Cocaethylene has an even more severe impact on cardiovascular function than cocaine, with its most serious effects impacting heart muscle contraction, heart rate, and blood pressure. These effects greatly increase the risk of heart attack, even after the first use.


    In addition, cocaethylene greatly increases the risk of stroke, even relative to the increased risk associated with cocaine abuse alone.

    Liver Damage

    Both cocaine and alcohol are hard on the liver, and chronic substance abuse often leads to liver dysfunction or failure. Cocaethylene increases and accelerates this damage, greatly increasing the risk that dangerous liver issues will develop.

    Violence & Aggression

    By increasing both dopamine and serotonin activity, cocaethylene is associated with sudden mood changes and increases in impulsiveness and aggression. This effect is known to trigger violence, potentially leading to physical altercations and personal harm.

    Learning Impairment

    Significant alcohol consumption has negative long-term effects on learning and cognitive function, effects which are further antagonized by cocaethylene.

     Harmful Effects Related To Pregnancy/Breastfeeding

    Combining cocaine and alcohol during pregnancy can result in miscarriage, stillbirth, premature birth, low birth weight, and developmental issues. Developmental issues are also possible if alcohol and cocaine are used prior to breastfeeding.  


    Alcohol and cocaine are an unfortunately common drug combination when it comes to drug fatalities. Death can occur as a result of overdose, cardiac arrest, stroke, or accidents related to drug-impaired judgment.

    Difficulty In Recovery

    Combination drug abuse (polydrug abuse) generally complicates the detoxification and recovery processes and increases the probability of relapse or other setbacks. 

    It’s also often associated with co-occurring physical and mental health issues such as depression, anxiety, or personality disorders.

    Treating Cocaine & Alcohol Use Disorders

    Alcohol abuse is a common co-occurring disorder with drug use disorders, and effective treatments have been developed to help you or your loved one overcome cravings and compulsions and make a lasting recovery.

    Treatment options may include:

    • inpatient treatment, hosted within a professional treatment center with medical supervision
    • outpatient treatment, which you can attend while continuing to live at home
    • cognitive behavioral therapy, or sessions that help you examine and change problematic thinking and attitudes related to substance use
    • group therapy, or treatment sessions where you meet with others who are also working on overcoming addiction for social support and encouragement

    To learn more, please contact Ark Behavioral Health today.

    Written by Ark Behavioral Health Editorial Team
    ©2024 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.
    Medically Reviewed by
    Davis Sugar, M.D.
    on July 9, 2022
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