The Big Night Out — & The Even Bigger Risk Of Mixing Alcohol & Cocaine

While travelling as a 20-year-old, Jess* (now 27), partied hard. It was a typical rite of passage. Alcohol and cocaine were available at the bars and the house parties, and it was normal for everyone to be taking them together at least twice a week. After six months, one night things changed: Jess witnessed a friend of the same age have a heart attack caused by the intoxication. “My whole mindset shifted,” she remembers. After this experience she completely cut cocaine out of her life. Another seven years passed and she decided to quit binge drinking, too. Although she hasn’t taken cocaine in all that time, she still remembers the impact it had on her overall wellbeing. “I’d struggle to get to sleep and my brain would be going at 100 miles an hour, usually with really negative thoughts. When I eventually could get to sleep I would then wake up not long after because my heart would be racing and it would be quite scary at times.”

Mixing booze with cocaine is pretty common for many cocaine users. One study in the U.S. estimated that up to 96% of people who use cocaine do so mixed with alcohol. Despite it being illegal and expensive, cocaine has become a normalised part and parcel (or baggie) of party culture, particularly in the UK, but consumption is also high in other parts of the world including Australia, Austria, Spain and America. Think about the events you go to where there’s booze — work events, weddings, house parties, birthdays, festivals, gigs, pub socials — someone is often passing around a bag of coke like it’s the most casual thing. Ketamine — which is also illegal — might be the current social drug of choice among Gen Z, but cocaine usage is still very much ingrained in drunken socialising. We only need to look at Charli XCX’s latest Brat vinyl release — which contains white powder (and although she hasn’t said it, it mimics the appearance of cocaine) — to see how cavalier attitudes to cocaine are. She’s had plenty of backlash from the sober community. Cocaine use has been glamourised long before Charli, and it will continue to be.

What many don’t realise is that when you take both cocaine and alcohol together, the liver creates a toxic mix known as cocaethylene. According to drugs charity WithYou, it makes the effects of alcohol and cocaine last longer but be more unpredictable. This chemical stays in the body for a longer period than cocaine alone, increases the chances of suffering a heart attack, and can damage the liver, heart and kidneys. It worryingly also can increase a person’s likelihood of inflicting self-harm or suicide. Millie Gooch, a sobriety advocate and founder of Sober Girl Society, shared her research and concerns about cocaethylene in a recent Tedx Talk. She noted that two former Love Island contestants who died by suicide had cocaine in their systems, something that was reported on at the time. Whilst not blamed for their untimely deaths, it’s vital information as the chances of acting on suicidal thoughts rise by 16 fold in the 24-hour period after taking both alcohol and cocaine. Gooch wants better awareness and understanding. Academics are concerned too, as Dr Rayyan Zafar recently told Mixmag that without realising it “people are more addicted to cocaethylene than they are to cocaine or alcohol,” adding that around 90% of cocaine users take it while drinking. Many cocaine users don’t know what it actually feels like to have it alone, as what’s happening internally is cocaethylene production.  

Dr. Bonnie Mitchell, clinical director at Healthy Life Recovery, calls the mixing of the two substances a “cocktail of potential disaster”. Alcohol, being a depressant (slowing the body and its reactions down), and cocaine being a stimulant (speeding up the heart rate, raising blood pressure and flooding the body with dopamine), “complicate” what’s happening mentally and physically. “The user is at a higher risk of physical danger associated with heart problems, alcohol poisoning, and possibly overdose. At the same time the user may complicate mental and behavioural issues like aggression, paranoia, violence and a potential for suicide.” Mitchell thinks there’s a huge knowledge gap. “Few studies have been done to explain the intense, psychoactive effect it has on the user,” she says. “Unfortunately the typical thoughts associated with mixing these go along the lines of ‘one balances out the other’, which is false.” Dr Hana Patel, from Superdrug Online Doctor, says a key problem she sees is many users don’t “realise they’re also prolonging the drug’s toxic effects in the body” while enjoying a seemingly enhanced high. “The false sense of control and reduced inhibitions can lead to reckless decisions. Without proper awareness, many unknowingly put themselves in life-threatening situations.” Fentanyl, a potent opioid that can easily be overdosed on, has even been found in cocaine.

Dry January just finished, and while many will celebrate with a pint (or six and a bump, a line, then another), others are continuing their sobriety, leaving behind “the sesh” and the mixing of substances. Lily*, 35, is one month sober. She went her entire teens and 20s never taking drugs, only drinking, until four years ago when she met her current partner who uses cocaine. “She was honest about using cocaine on a regular basis. I was very much of the mindset ‘That's your choice but it's not for me’. I have two children so it hadn't ever crossed my mind to use it and it wasn't something any of my friends did, so it was never around me,” she says. “But it got to a point where I didn't like not knowing how it was affecting my partner as I had no experience of it. Then we got to the conversation of ‘Just try it and you'll realise it's not as bad as you think’. So I did.” Lily’s drug use then escalated to sometimes weekly usage. Drinking and cocaine made her feel like a new person, not an ex-wife or a survivor of domestic violence. She’d go out for escapism and freedom, then return home back to the “responsible version” of herself. 

When Lily and her partner moved in together, if Lily’s children were out, it became a thing they would do together on the weekends “just because we could”. Not only did it affect their relationship, Lily noticed she’d always wake up after feeling terrible. “The anxiety was nothing like I've ever experienced before,” she says. “I wouldn't sleep for nights following because I'd get itchy skin, hot sweats, and heart palpitations.” What cocaine seemingly gave her to begin with — a different sense of identity — quickly didn’t seem worth it so she stopped using. “Since going sober, I feel like a switch has gone off in my brain. The desire has gone and if anyone mentions drinking or coke or any other drugs it literally turns my stomach. I don't want to be that version of myself ever again.” She no longer feels sluggish, is more present, feels happier, and is more organised.

Men and women process drugs and alcohol slightly differently. The research gap is particularly bad for women. Mitchell says that “people who combine cocaine and alcohol may experience a longer-lasting, more intense, psychoactive effect, but few studies have been done to reveal the role gender plays on addiction”. She says that research she’s seen shows women have “more susceptibility to alcohol-mediated brain damage and a higher sensitivity to cocaine in relation to the menstrual cycle and hormones”. Limited data also found that women use more cocaine and can be less compliant to therapy than men, she adds.

Communities, like Sober Girl Society, can help women feel supported in their sobriety journeys. Tasha*, 47, has been sober for 13 months and is a part of that online group. Since going sober, “everything in my life has been easier”, she says. “I was a regular drink and cocaine user, mostly when out with friends and going out to bars or even over to people’s houses for dinners. Basically any occasions where drink was involved would undoubtedly lead to someone calling in the cocaine. The two basically go hand in hand socially and the mix makes you feel confident and able to talk to anyone.” Now, she trades hungover Saturday mornings for 9 a.m. Park Runs and says her fitness is the best it's ever been. 

Olivia*, 33, is in the same community, and has been sober for over two years. Though she used a variety of drugs, she would distinctly only ever use cocaine when already drunk. Working as a musician meant there was an abundance around her. Olivia’s memories of the nights themselves are hazy, as the combo would make her memory blackout, but the days after she remembers vividly. “I was having multiple-day hangovers and anxiety was at an all time high,” Olivia says. She says she also had to confront “bad decisions” made under the influence that hurt people she cares about. “I didn’t realise at the time, but my personality completely changed. I was irrational, irritable, impulsive, self-centred and depressed, but it was a vicious cycle of using drinking and drugs to escape the depression.” Since going sober, she’s had to face these difficult feelings head on, but ultimately loves waking up “with a clear head and a clear conscience”. 

The reality is that people will continue to take cocaine and alcohol together, given how commonplace it is. At Refinery29, we advise against all use of the illegal drug. However, for those who are going to do it, an understanding of the risks has been lacking from the conversation for too long. Finally, people are starting to advocate for better drug safety awareness.