When someone is abusing cocaine, the body quickly metabolizes the substance and the associated euphoria lasts upwards of just 15 minutes. Alcohol, a depressant drug, slows the metabolism of cocaine and, in effect, increases the high and length of time this euphoria is experienced.
However, when these substances are combined, metabolism of both substance is slowed by approximately 20 percent, increasing exposure to these toxic substances, as well as metabolites resulting from simultaneous exposure to cocaine and alcohol.
How Does Alcohol Combined With Cocaine Increase Toxicity?
Apart from adding one toxic substance to another, when someone uses cocaine, then drinks alcohol, a dangerous metabolite is also produced. The metabolite, cocaethylene, is not only toxic, but far more toxic than cocaine or alcohol alone. Testing on laboratory animals reveals a 30 percent increase in toxicity, and combined with the dramatic slowing of metabolism caused by the introduction of alcohol to the system, this elevated toxicity is sustained for hours longer than when the substances are abused individually.
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Cocaethylene has many adverse health effects, most notably heart failure, liver failure, and sudden death. One study on laboratory animals revealed that increased cocaethylene resulting from exposure to alcohol and cocaine lead to overall reduced cardiovascular functioning and even death for some of the animals included in the study.
During the use of these substances, the brain, cardiovascular system, and liver are put under enormous stress for a period often lasting 12 hours, long after the feelings associated with the drugs wear off. As the person comes down off the high experienced by the use of the drugs together, they may seek to achieve the same high by combining these drugs again, within that initial 12-hour period or immediately following. The taxing effects of the combination on the body is one of the primary mechanisms for sudden death related to cocaine addiction.
Use of cocaine also slows the effects of alcohol, so someone consuming alcohol while using cocaine may feel that they can drink more, leading to binge drinking and a substantial increase in the risk of alcohol poisoning.
The brain of someone abusing cocaine is significantly changed in a short period of time. Reduced blood flow reduces oxygen to vital brain cells. Cumulative damage caused to the cardiovascular system from alcohol abuse can further reduce blood flow to vital organs, including the brain. Brain shrinkage is reported in those who abuse alcohol due to the death of grey and white matter cells. This can create significant and lasting cognitive impairment for an individual battling addiction.
Other Risks Associated With Alcohol And Cocaine
Apart from the known physiological risks associated with combining alcohol and cocaine, mood changes associated with the combination and resulting metabolites increase aggression in humans. This combined with alcohol-induced aggression and the stimulant aspect of the cocaine can produce some violent outbursts from individuals consuming the combo.
With more than five million people claiming to have used alcohol and cocaine together in the US alone, during one single year survey, many of these users are women. Women generally are more vulnerable to physical and sexual violence while abusing substances like cocaine and alcohol. Studies of the effects of alcohol and cocaine combined on fetal development indicates the toxicity from the substances interferes with normal brain development.
Evidence-Based Treatment Of Co-occurring Alcohol And Cocaine Addiction
There has never been a true one size fits all approach to treating drug and alcohol addiction. The same is true for treating co-occurring alcohol and cocaine addiction. Studies indicate specific treatment types show greater efficacy over others. Of these, cognitive behavioral therapy (CBT) is one of the most successful treatment types for addressing co-occurring alcohol and cocaine abuse. Contingency management (CM), a subset of behavioral therapy and motivational enhancement therapy, uses a system of reward to address progress made in treatment.
Motivational enhancement therapy (MET) shows some promise with treating the co-occurring disorders, though the data does not yet support its efficacy when used alone to treat the addiction disorder. A twelve-step program also shows some limited promise. Either may be more effective when combined with CBT or CM.
Naltrexone, disulfiram, topiramate, valproate, or baclofen are pharmacotherapies that may be used in conjunction with one of the treatment types mentioned earlier, though none show significant promise as a solid treatment for a co-occurring addiction to both cocaine and alcohol. They may be used to address cravings in the early stages of recovery.
Overall recovery successes were improved with combined use of multiple therapeutic approaches, over a single approach.