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Mixing Cocaine With Other Drugs: How Does This Affect Detox?

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Many people struggling with cocaine addiction choose to enter a detox program to increase their comfort and ensure their safety during withdrawal. With that said, using other substances, such as opioids or alcohol, in addition to cocaine, can severely impact and complicate the detox process.

Mixing Cocaine With Other Drugs: How Does This Affect Detox?

person cutting lines of cocaine
Cocaine is an addictive stimulant substance derived from South American coca plant leaves. People may use cocaine in several ways, including snorting it through the nose, dissolving it into water and injecting it, rubbing it on the gums, or smoking a processed, freebase form of the drug (crack cocaine). A common intravenous drug combination is cocaine and heroin, which is typically referred to as a “speedball.”1

On its own, cocaine use can produce feelings of extreme euphoria, mental alertness, and increased energy; however, cocaine use may also cause paranoia and irritability and can lead to bizarre, unpredictable, and even violent behavior.1

Cocaine users may mix the stimulant with other substances, such as heroin, benzodiazepines, or alcohol, for a variety of reasons.2-4,11 Polydrug abuse can greatly impact the detoxification process, as some medical complications associated with alcohol and benzodiazepine withdrawal, such as grand mal seizures or delirium tremens, can be life-threatening.3

Why Do People Combine Cocaine & Other Substances?

Cocaine, heroin and pills on table
Many people use cocaine and drink alcohol at the same time. This can be done to:2

  • Amplify the high experienced with either substance alone.
  • Reduce feelings of drunkenness.
  • Decrease the unwanted symptoms associated with cocaine “comedown.”

People may also use cocaine and heroin simultaneously (a practice known as “speedballing”), as the combination of the stimulant with the opioid can create a “push-pull” reaction in the brain and body. Cocaine and heroin are used together for a number of different reasons, depending on the intended goal. People may use both drugs in attempts to enhance the euphoria or high, in hopes that the individual negative side effects are minimized.6 Some people may use cocaine in an attempt to mitigate the intensity of heroin withdrawal symptoms.5 However, combining heroin and cocaine can have potentially deadly consequences. In addition to causing severe confusion, stupor, impaired coordination and cognition, speedballing can also increase the risk of aneurysm, heart attack, and stroke.6

Further, the use of speedballs can also increase the risk of overdose due to profound respiratory depression. This is because cocaine can mask the sedating effects of heroin, causing the individual to use more heroin than they typically would. Cocaine intoxication doesn’t last nearly as long as heroin’s, so once the cocaine wears off, then heroin’s effects are felt in full. This is when respiratory failure, overdose, and death can occur.6

Finally, people may also mix benzodiazepines, such as Xanax or Klonopin, with cocaine under the assumption that they can minimize some of the unpleasant symptoms associated with stimulant use, such as anxiety or agitation.11 Some patients risk respiratory depression if they take high doses of benzodiazepines to ward off the unpleasant symptoms of withdrawing from cocaine.7

While using cocaine is inherently dangerous on its own, combining it with other substances is particularly risky. Polydrug abuse often increases the likelihood of serious medical consequences or death.

The Detox Process

People struggling with a cocaine addiction often benefit from receiving detox services to support the uncomfortable physical and psychological symptoms associated with acute withdrawal.

Some of these distressing cocaine withdrawal symptoms can include:3,8

  • Depression.
  • Anxiety.
  • Irritability.
  • Poor concentration.
  • Fatigue.
  • Paranoia.
  • Psychomotor agitation.
  • High drug cravings.
  • Vivid and unpleasant dreams.
  • Hypersomnia or insomnia.

Cocaine withdrawal symptoms can develop within a few hours to several days after the last use. Many people experience a “crash” after heavy cocaine use, and withdrawal symptoms can appear relatively quickly, as cocaine has a short half-life, meaning that the body eliminates it quickly.12

Although cocaine withdrawal by itself is not generally fatal, depression can occur in those going through withdrawal. This depression can become severe in some cases and may be associated with suicidal thoughts and behaviors.3,11 Further, seizures can also occur during cocaine detoxification, although it is considered a medical complication and not typical of the cocaine withdrawal syndrome.3 Because of these risks, a detox program can greatly benefit someone attempting to quit cocaine, as staff members provide support and care necessary to jumpstart recovery.

You may be wondering what it’s like to enter a detox program. While every program is different, the Substance Abuse and Mental Health Service Administration (SAMHSA) emphasizes that there are 3 key parts of detox that every program should have. These elements include:3

  • Evaluation: During this phase, the medical team tests for the presence of drugs in the bloodstream and screens for physical and mental health disorders. A doctor or other mental health professional conducts a biopsychosocial assessment, which examines the person’s social, psychological, and physical health. The evaluation is then used to create an individualized detox plan.
  • Stabilization: During this phase, the staff members provide proper interventions to manage acute intoxication (if applicable) and withdrawal symptoms to reach a stable, sober state.
  • Referral to addiction treatment: During this phase, staff members educate the patient on the importance of receiving comprehensive substance abuse treatment to help build a foundation for obtaining and maintaining sobriety.

Although the FDA has not clinically approved any medications to manage cocaine withdrawal, researchers have begun exploring some potential options. For example, amantadine and disulfiram (Antabuse) may help decrease cocaine use in individuals experiencing intense withdrawal symptoms, and modafinil, a stimulant drug prescribed for narcolepsy and other sleep-related disorders, is being investigated for use during cocaine detoxification. More research is needed to confirm the utility of these medications.3

Cocaine detox can be managed on either an inpatient or outpatient basis. Inpatient detox programs provide 24-hour detox treatment and support to mitigate potential dangers of withdrawal and to adequately treat any conditions or complications that may be present or may arise throughout the process. Outpatient programs entail scheduled meetings with a counselor or medical professional at a detox facility, while allowing the patient to return home in the evening. The level of care will be determined depending on a variety of factors, including symptom severity and suicide risk.3

The Impact of Polydrug Use

As previously mentioned, polydrug use can significantly impact the cocaine detox process, making it far more risky than on its own. During withdrawal, people who also abuse alcohol, benzodiazepines, and some other sedating drugs risk grand mal seizures, which can be fatal, or delirium tremens, which is characterized by hallucinations and delusions, and can increase the risk of death due to erratic, bizarre, or violent behaviors.3 Some individuals who engage in co-occurring alcohol and cocaine use may experience cardiac complications during withdrawal, including arrhythmia and heart attack.3 At this point, it is impossible to pinpoint who will or will not experience these dangerous symptoms during the detox process, but heavy, long-term users tend to have a greater risk.

"Help" spelled in cocaine powder
If a person is using heroin and cocaine, withdrawal may not be inherently deadly, but the process can be highly distressing and painful. By nature, opioid withdrawal is extremely unpleasant, with some of the more uncomfortable symptoms including:3

  • Fever.
  • Excessive sweating.
  • Vomiting.
  • Severe abdominal cramps.
  • Diarrhea.
  • Bone and muscle pain.
  • Profound anxiety.
  • Increased autonomic activity (high blood pressure, fast pulse, etc.).

Because the withdrawal symptoms resulting from mixing cocaine with other drugs can lead to significant suffering and even death, it is often recommended that polydrug users seek a 24-hour care setting for support and monitoring. Such support can help alleviate the discomfort, reduce the risk of relapse, and ensure the patient’s safety.3

That being said, if you are unsure about what level of care you need, it is always wisest to receive a thorough assessment from a doctor or mental health professional before choosing a program. The assessment provides an overview of a person’s physical and psychological health and can help to determine the type and duration of detox treatment necessary.

Other Detox Medications

Many polydrug users benefit from medication to reduce cravings and mitigate withdrawal symptoms. Those who use more than one drug may need additionally specialized treatment and intervention for treating all the substances they use, but some examples of common detox medications include:3,10

Opioid detox medications: Currently, methadone, buprenorphine, and Suboxone (buprenorphine/naloxone combination drug) are used during opioid detox. They help to minimize withdrawal symptoms and reduce cravings.

Alcohol detox medications: The medications of choice for managing alcohol withdrawal are benzodiazepines, such as Valium or Klonopin, which are then gradually tapered off throughout the detox process.

Benzodiazepine detox medications: If the person is addicted to or dependent on a benzodiazepine with a short half-life, the drug may be replaced with a benzodiazepine that has a longer half-life, such as Librium (chlordiazepoxide), or a long-acting barbiturate, such as phenobarbital. Another option is that the patient may be gradually tapered off of the benzo of abuse.

Co-occurring mental health disorders: People with co-occurring mental disorders, such as depression or anxiety, may be prescribed specific, psychiatric medications to reduce negative symptoms.


It is important to note that anyone struggling with polydrug use can benefit from the support and structure offered within professional treatment settings. Although detox can feel like a terrifying first step, learning about the process and knowing what to expect can simplify you or your loved one’s decision in seeking help.

 Sources

  1. National Institute on Drug Abuse. (2016). What is Cocaine?
  2. European Monitoring Centre for Drugs and Drug Addiction. (2011). Cocaine and Alcohol.
  3. Substance Abuse and Mental Health Services Administration. (2006). Quick Guide for Clinicians: Detoxification and Substance Abuse Treatment.
  4. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators.
  5. Leri, F., Bruneau, J., Stewart, J. (2002). Understanding Polydrug Use: Review of Heroin and Cocaine Co-Use. Addiction, 97(7): 773–83.
  6. National Institute on Drug Abuse for Teens. (2013). Real Teens Ask About Speedballs.
  7. North Brisbane Partners in Recovery. (N.D.). Stimulants & Benzodiazepines.
  8. U.S National Library of Medicine. (2017). Cocaine Withdrawal.
  9. The University of Arizona. (2006). Medical Complications.
  10. National Institute on Drug Abuse. (2018). Treatment Approaches for Drug Addiction.
  11. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  12. Australian Government Department of Health. (2004). The cocaine withdrawal syndrome.

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