La cocaïne s'affirme comme la drogue de M. et Mme Tout-le-Monde

Il entraîne des effets violents sous forme de flash - certains parlent d'un effet " coup de fusil " -

Vous croyez qu'ils ont voulu faire un "shoot" à  la française?

Il faut savoir que la cocaine entraine des effets vasculaires (jusqu'à  accident vasculaire cerebral et infarctus du myocarde) même chez les jeunes consommateurs. J'ai discuté avec des urgentistes qui, à  la suite d'une reprise des dossiers, ont decouvert que certains de ces accidents n'avaient pas été attribués à  la cocaine au moment du passage aux urgences, probablement parce que le resultat des tests d'urines avait été reçu par la suite.
Il y a donc probablement actuellement  une sous evaluation de ce  risque.

Rappelons aussi que la cocaine et l'alcool (et bien sûr l'association des deux) sont les produits les plus toxiques pour le foetus chez la femme enceinte.
Amicalement

A Bighorsse,
Ce n'etait pas une critique de ta reponse mais un complement au premier message, qui n'en parle pas.
Amicalement

Tout à  fait. Je joins une courte phrase en français (trouvée sur Internet) et des details mais malheureusement je n'ai pas trouvé en français, donc c'est en anglais.
Amicalement

Cocaéthylène
Substance psychoactive obtenue par mélange de cocaïne et d'alcool. Elle présente une activité et une toxicité proches de celles de la cocaïne, avec une demi-vie prolongée. Sa rémanence dans l'organisme augmente le risque d'accidents neurologiques, d'atteintes hépatiques et de perturbation du système immunitaire. Les risques de décès brutal sont également sensiblement majorés.

Quelques details en anglais

Cocaethylene:

Responding to combined

alcohol and cocaine use

Summary

Cocaethylene is a unique compound formed when alcohol and cocaine are combined.

Cocaethylene has been associated with increased health and social risks, although

understanding and awareness of the risks appears low. Scope to improve knowledge and

responses within drug and alcohol strategy approaches appear important given

indications of increasing popularity of combined alcohol and powder cocaine use.

Key findings:

ï‚·

ï‚·

ï‚·

ï‚·

ï‚·

Qualitative data based on survey findings, reports from professionals and users

suggests combined alcohol and cocaine use is a significant and increasing trend,

particularly amongst young recreational  „binge”Ÿ drinkers

There is a broad consensus that cocaethylene significantly increases risk of heart

attack and other possible health effects. It is also linked to other social harms such

as an increased propensity to violence amongst users

Further understanding about the increased health and social risks resulting from

combined alcohol and cocaine use is lacking; however some figures are commonly

recited such as significantly increased risks of sudden death or heart attack

There is limited quantitative data about the actual prevalence, use or

understanding of cocaethylene specifically, although extensive separate data on

alcohol and cocaine use can be corroborated to some extent

Available statistical data indicates high combined levels of alcohol and cocaine

use: the NTA report that around 75% of those in treatment for powder cocaine

reported alcohol use at start of treatment. 61% of those reporting powder cocaine

use in the Mixmag survey said they  „always drank alcohol when snorting cocaine”Ÿ

Key recommendations:

ï‚·

ï‚·

ï‚·

Brief interventions and psychosocial treatment can be effective for both alcohol

and cocaine users - optimum approaches should be explored for combined users

Practitioners should be offered training and guidance to better understand and

respond to the needs of combined alcohol and cocaine users

The impact of combined alcohol and drug use needs further research and

increased recognition within drug and alcohol strategy approaches

1

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

1. Background

Cocaethylene is reported to produce heightened euphoria amongst users, with a more

prolonged effect than taking cocaine on its own. However concerns over greater health

risks have been increasingly discussed following further research into the subject.

However there has been debate over the actual impact and risks of combined use, and

the consensus appears to remain that further research is needed.

The most commonly recited effect of cocaethylene, as given in a 1990 New Scientist

article1, asserts that “When cocaine and alcohol are taken together, the combination is 21

times more likely to kill people with severe heart problems than cocaine on its own.”

Whilst this statistic has been disputed, there is consensus that the effect of cocaethylene

increases the risk of cardiac problems and other possible effects such as seizures and

liver damage. It has also been linked to an increased risk of violent and impulsive

behaviour.

Anecdotal reports from practitioners and those in the drug and alcohol field suggest that

increasingly drinkers in the UK are intentionally poly-using cocaine. This is largely

corroborated by significant increases in powder cocaine use as explored in recent

cocaine reports by the House of Commons Home Affairs Committee and National

Treatment Agency. Yet reports also suggest combined users are largely unaware of the

increased health and social risks presented by their combined use.

Currently there appears to be limited recognition of the potential health or social impacts

of combined alcohol and cocaine use amongst users or policy makers. Although the

deliberate use of alcohol and cocaine is not a new phenomenon, current drug and alcohol

policies are not geared to address the future impact of potentially significant increases in

use.2 This paper therefore aims to explore current understanding, gaps in learning and

opportunities for local and national drug and alcohol leads to respond.

„Vin Mariani”Ÿ, a  „tonic”Ÿ wine which contained

cocaine was popular in the 19th century. It

claimed to  „fortify and refresh body and brain”Ÿ,

and was also promoted as a treatment for a

range of conditions. Fans reportedly included

Queen Victoria and Pope Leo XIII awarded the

wine a Vatican gold medal, also endorsing it on

a poster.

2

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

2. What is ‘Cocaethylene´?

When alcohol and cocaine are exposed in the liver, they form a unique metabolite

ethylbenzoylecgonine (cocaethylene). Whilst the effect is similar to the metabolite formed

by cocaine (benzoylecgonine), several differences are observed affecting the

psychoactive and biological impacts on the body.

Most significantly, cocaethylene (like cocaine) blocks the re-uptake of dopamine3 in the
Cocaethylene:

Responding to combined

alcohol and cocaine use

Summary

Cocaethylene is a unique compound formed when alcohol and cocaine are combined.

Cocaethylene has been associated with increased health and social risks, although

understanding and awareness of the risks appears low. Scope to improve knowledge and

responses within drug and alcohol strategy approaches appear important given

indications of increasing popularity of combined alcohol and powder cocaine use.

Key findings:

ï‚·

ï‚·

ï‚·

ï‚·

ï‚·

Qualitative data based on survey findings, reports from professionals and users

suggests combined alcohol and cocaine use is a significant and increasing trend,

particularly amongst young recreational  „binge”Ÿ drinkers

There is a broad consensus that cocaethylene significantly increases risk of heart

attack and other possible health effects. It is also linked to other social harms such

as an increased propensity to violence amongst users

Further understanding about the increased health and social risks resulting from

combined alcohol and cocaine use is lacking; however some figures are commonly

recited such as significantly increased risks of sudden death or heart attack

There is limited quantitative data about the actual prevalence, use or

understanding of cocaethylene specifically, although extensive separate data on

alcohol and cocaine use can be corroborated to some extent

Available statistical data indicates high combined levels of alcohol and cocaine

use: the NTA report that around 75% of those in treatment for powder cocaine

reported alcohol use at start of treatment. 61% of those reporting powder cocaine

use in the Mixmag survey said they  „always drank alcohol when snorting cocaine”Ÿ

Key recommendations:

ï‚·

ï‚·

ï‚·

Brief interventions and psychosocial treatment can be effective for both alcohol

and cocaine users - optimum approaches should be explored for combined users

Practitioners should be offered training and guidance to better understand and

respond to the needs of combined alcohol and cocaine users

The impact of combined alcohol and drug use needs further research and

increased recognition within drug and alcohol strategy approaches

1

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

1. Background

Cocaethylene is reported to produce heightened euphoria amongst users, with a more

prolonged effect than taking cocaine on its own. However concerns over greater health

risks have been increasingly discussed following further research into the subject.

However there has been debate over the actual impact and risks of combined use, and

the consensus appears to remain that further research is needed.

The most commonly recited effect of cocaethylene, as given in a 1990 New Scientist

article1, asserts that “When cocaine and alcohol are taken together, the combination is 21

times more likely to kill people with severe heart problems than cocaine on its own.”

Whilst this statistic has been disputed, there is consensus that the effect of cocaethylene

increases the risk of cardiac problems and other possible effects such as seizures and

liver damage. It has also been linked to an increased risk of violent and impulsive

behaviour.

Anecdotal reports from practitioners and those in the drug and alcohol field suggest that

increasingly drinkers in the UK are intentionally poly-using cocaine. This is largely

corroborated by significant increases in powder cocaine use as explored in recent

cocaine reports by the House of Commons Home Affairs Committee and National

Treatment Agency. Yet reports also suggest combined users are largely unaware of the

increased health and social risks presented by their combined use.

Currently there appears to be limited recognition of the potential health or social impacts

of combined alcohol and cocaine use amongst users or policy makers. Although the

deliberate use of alcohol and cocaine is not a new phenomenon, current drug and alcohol

policies are not geared to address the future impact of potentially significant increases in

use.2 This paper therefore aims to explore current understanding, gaps in learning and

opportunities for local and national drug and alcohol leads to respond.

„Vin Mariani”Ÿ, a  „tonic”Ÿ wine which contained

cocaine was popular in the 19th century. It

claimed to  „fortify and refresh body and brain”Ÿ,

and was also promoted as a treatment for a

range of conditions. Fans reportedly included

Queen Victoria and Pope Leo XIII awarded the

wine a Vatican gold medal, also endorsing it on

a poster.

2

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

2. What is ‘Cocaethylene´?

When alcohol and cocaine are exposed in the liver, they form a unique metabolite

ethylbenzoylecgonine (cocaethylene). Whilst the effect is similar to the metabolite formed

by cocaine (benzoylecgonine), several differences are observed affecting the

psychoactive and biological impacts on the body.

Most significantly, cocaethylene (like cocaine) blocks the re-uptake of dopamine3 in the

brain, producing euphoric but habit forming reward effects. Because cocaethylene has a

longer half-life than cocaine on its own, the euphoric effects are prolonged. Cocaethylene

increases the levels of cocaine in the blood, which is cleared more slowly (the half-life).

Additionally, cocaethylene has a less significant effect in regulating serotonin than

cocaine, also thought to increase euphoric effects.

The affect of cocaine on

the brain

Cocaine interrupts the

natural re-absorption of

dopamine in the brain.

Dopamine results in

signals that create a

feeling of euphoria.

Cocaethylene further

blocks the re-uptake

causing a greater build up

of dopamine and longer

sense of euphoria.

Source: National Institute on

Drug Abuse (NIDA)

Evidence suggests that the ingestion of alcohol before cocaine is required to create

cocaethylene (McGowan 20084).

3. Increased health and social risks?

The extent of the increased risk of cocaethylene appears hard to quantify in non-medical

terms, although there has been a significant degree of academic research into its nature

as a compound and various interactions5. There is therefore varied reporting about the

actual risks in terms of death or serious health conditions as explored below.

3

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

3.1 Affect on the body

Cocaine use is linked to cardiovascular problems especially increased heart rate and

blood pressure. These risks have been demonstrated to be further increased by

cocaethylene. A study in 1997 (Farre et al) found that whilst cocaine increased heart

rates by 12 beats per minute (BPM), cocaethylene increased heart rates by 33 BPM.

Increased heart risks are thought to be concomitant with up to 30% increased blood

cocaine levels when cocaethylene is formed6.

Cocaethylene”Ÿs increased health risks, especially for those with heart conditions has

been linked to cocaine”Ÿs ability to block sodium channels of cardiac cells - this blocking

effect is thought to be greater from cocaethylene than cocaine (Xu et al, 19947).

Additionally cocaethylene is a myocardial depressant, which means the drug impairs the

strength and force of the heart”Ÿs contractile function. This can lead to heart failure in

some individuals, which may persist despite abstaining from the drug in the future. A

recent paper  „Neurotoxic and Cardiotoxic Effects of Cocaine and Ethanol”Ÿ8 concluded

that:

“The combination of ethanol and cocaine has been associated with a significant increase

in the incidence of neurological and cardiac emergencies including cerebral infarction,

intracranial haemorrhage, myocardial infarction, cardiomyopathy, and cardiac

arrhythmias.”

The New Scientist article  „Science: Cocaine and alcohol make a heart-stopping cocktail”Ÿ9

published in 1990 stated:

“In tests with mice, scientists have found that cocaethylene is between 50 and 100 per

cent more lethal than cocaine. However, Mash says that the jury is still out on why it kills

people. Cocaine and cocaethylene may disrupt the function of the limbic parts of the brain

which control the heart, she says. They also bind to other molecules in the brain, known

as muscinaric and sigma receptors. These have been linked with abnormal heart

function, mental disorders, and also with delirium.”

The US National Institute on Drug Abuse (NIDA) report in a Research Report Series

paper10 on cocaine states:

“While more research needs to be done, it is noteworthy that the mixture of cocaine and

alcohol is the most common two-drug combination that results in drug-related death.”

4

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

However cocaine-related health risks have a better recognition as a lone drug,

particularly in terms of the impact on the heart. Recent national  „Frank”Ÿ campaigns have

highlighted the risk to the heart in particular:

“Cocaine is highly risky for anybody with high blood pressure or a heart condition.

Perfectly healthy, young people can have a fit or heart attack after taking too much coke

and you may not know you”Ÿve got a pre-existing heart condition.” www.talktofrank.com

However the role of alcohol in the research behind cocaine harms is commonly

overlooked. A 2008 article in The Times called  „The New Cocaine Crisis”Ÿ11 reported that

A&E presentations of young revellers with heart problems had become so common they

had been labelled  „coke strokes”Ÿ by A&E staff. The article explores in particular the

frequency of cocaine-related Saturday night emergency admissions:

“The problem, though, is that getting high at weekends can put huge strain on the heart:

cocaine, in particular, constricts the blood vessels, raising blood pressure and making the

heart work harder. Throw in alcohol and amphetamines, and you have what some

doctors believe is a  „ticking time bomb of acute cardiac problems”Ÿ.”

3.2 Increased risk of violence?

The consequences of combined alcohol and cocaine use may not only be health related;

professionals point out that cocaine”Ÿs stimulant effect reduces a drinker”Ÿs feeling of

intoxication and allows greater quantities of alcohol to be consumed. Furthermore, with

the disinhibiting effect of alcohol combined with a heightened sense of self confidence

associated with cocaine, the links between increased violent or impulsive behaviour seem

logical.

Both alcohol and cocaine elevate extraneuronal dopamine and serotonin levels which in

turn may lead to deficits in impulse control and, thus, violent behaviour12. It is therefore

possible to hypothesise that the combination of alcohol and cocaine increases the risk of

violence than either drug taken alone. There is some research from the US that suggests

that combined alcohol and cocaine use increases the risk of violence (Chermack & Blow

200113; McDonald et al, 200814). In a separate review of the research evidence on

cocaethylene and violence, Penning et al. (2002) noted that:

“Retrospective research on violence suggests a major role for alcohol alone and additive

increases in violent behaviour or crime from the combination [with cocaine]. For ethical

reasons, high repeated doses of cocaine have not been studied experimentally. The

behavioural toxicity of highdose binge use of cocaine with alcohol may thus be

5

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

underestimated. One study shows a potentiation effect of the cocaine-alcohol

combination on the number of thoughts and threats of violence” 15

Volume 24 (March/April 2009) of Druglink magazine featured an article entitled  „The

hidden mixer”Ÿ16 exploring the possible link between combined alcohol and cocaine use

and violence. It reported that drug tests by Greater Manchester police had found that

„between a quarter and a third of people arrested for violence snorted powder cocaine

before fighting.”Ÿ However the article concluded that alcohol was still the most likely drug

affecting the risk of violent behaviour, and that personality is still the key determining

factor.

It has yet to be established exactly how and under what circumstances the combination

of alcohol and cocaine may give rise to increased risk of aggression and violence. There

is currently a shortage of in depth research which includes the role of important social

and contextual factors such as the night-time economy or domestic settings17. Further

exploration of combined use in violent offences could provide additional insight. Models of

data collection such as the Cardiff A&E data sharing model and initiatives such as alcohol

arrest referral schemes could be important opportunities to further explore risk factors

and prevalence relating to combined alcohol and cocaine use.

3.3 Addiction risks?

There appears to be insufficient research to assess whether combined cocaine and

alcohol use is likely to increase levels of addiction to either drug, or whether there is the

possibility of a particular habit-forming reaction to cocaethylene. A medical review of the

literature available on the psychological and somatic consequences of combined use

found no evidence that cocaethylene produced an enhanced addictive effect (McGowan,

2008). However one early study18 on cocaethylene concluded that  „The formation of

cocaethylene may play an important role in the systemic toxicity and abuse liability

associated with dual addiction to cocaine and alcohol.”Ÿ

Nonetheless, the already strong tendency of each drug to form a variety of physical and

psychological disorders without a combined synergy should not be overlooked. It has also

been suggested that  „some combined use can be explained by classical conditioning

theory. A combined user has their alcohol and cocaine use conditioned together so that

using one brings on the craving or desire to use the other.”Ÿ (McGowan, 2008). Anecdotal

reports also suggest that the  „crash”Ÿ or  „comedown”Ÿ effects of cocaine are reduced if

combined with alcohol, which may also be likely to lead to increased conditioning of poly-

use.

6

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

4. Use and prevalence of cocaethylene

Whilst medium to longer term trends of both cocaine and alcohol consumption have been

rising, there is little specific data available directly identifying cocaethylene prevalence.

However anecdotal reports suggest that many drinkers in the UK now see cocaine as an

integral part of their recreational alcohol use. A qualitative study19 of 34 young cocaine

users in London found that:

„Virtually everyone interviewed reported that they regularly drank alcohol when using

cocaine. Reports of drinking more heavily than usual while under the influence of cocaine

were widely described, with several reporting that they often drank at least twice their

usual alcohol intake. For a significant number of respondents, cocaine use was always

accompanied by alcohol. Some used cocaine to moderate the undesirable effects of

alcohol (such as feeling less in control and unsteady on their feet), so that they could

continue to drink. In contrast, others used alcohol in a functional way to moderate the

effects of cocaine: to help them take the edge off feelings of anxiety or paranoia and to

help them to sleep at the end of the evening. As Kate, an unemployed 22-year-old,

explained:

„I won”Ÿt have cocaine without alcohol. Because when you have cocaine on its own it”Ÿs a

completely different buzz. You can get on a paranoid buzz if you have it on its own. The

alcohol brings you on a level.”Ÿ (Kate, aged 22)

Overall, respondents reportedly recognised very few risks associated with using cocaine

and alcohol together.”Ÿ

brain, producing euphoric but habit forming reward effects. Because cocaethylene has a

longer half-life than cocaine on its own, the euphoric effects are prolonged. Cocaethylene

increases the levels of cocaine in the blood, which is cleared more slowly (the half-life).

Additionally, cocaethylene has a less significant effect in regulating serotonin than

cocaine, also thought to increase euphoric effects.

The affect of cocaine on

the brain

Cocaine interrupts the

natural re-absorption of

dopamine in the brain.

Dopamine results in

signals that create a

feeling of euphoria.

Cocaethylene further

blocks the re-uptake

causing a greater build up

of dopamine and longer

sense of euphoria.

Source: National Institute on

Drug Abuse (NIDA)

Evidence suggests that the ingestion of alcohol before cocaine is required to create

cocaethylene (McGowan 20084).

3. Increased health and social risks?

The extent of the increased risk of cocaethylene appears hard to quantify in non-medical

terms, although there has been a significant degree of academic research into its nature

as a compound and various interactions5. There is therefore varied reporting about the

actual risks in terms of death or serious health conditions as explored below.

3

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

3.1 Affect on the body

Cocaine use is linked to cardiovascular problems especially increased heart rate and

blood pressure. These risks have been demonstrated to be further increased by

cocaethylene. A study in 1997 (Farre et al) found that whilst cocaine increased heart

rates by 12 beats per minute (BPM), cocaethylene increased heart rates by 33 BPM.

Increased heart risks are thought to be concomitant with up to 30% increased blood

cocaine levels when cocaethylene is formed6.

Cocaethylene”Ÿs increased health risks, especially for those with heart conditions has

been linked to cocaine”Ÿs ability to block sodium channels of cardiac cells - this blocking

effect is thought to be greater from cocaethylene than cocaine (Xu et al, 19947).

Additionally cocaethylene is a myocardial depressant, which means the drug impairs the

strength and force of the heart”Ÿs contractile function. This can lead to heart failure in

some individuals, which may persist despite abstaining from the drug in the future. A

recent paper  „Neurotoxic and Cardiotoxic Effects of Cocaine and Ethanol”Ÿ8 concluded

that:

“The combination of ethanol and cocaine has been associated with a significant increase

in the incidence of neurological and cardiac emergencies including cerebral infarction,

intracranial haemorrhage, myocardial infarction, cardiomyopathy, and cardiac

arrhythmias.”

The New Scientist article  „Science: Cocaine and alcohol make a heart-stopping cocktail”Ÿ9

published in 1990 stated:

“In tests with mice, scientists have found that cocaethylene is between 50 and 100 per

cent more lethal than cocaine. However, Mash says that the jury is still out on why it kills

people. Cocaine and cocaethylene may disrupt the function of the limbic parts of the brain

which control the heart, she says. They also bind to other molecules in the brain, known

as muscinaric and sigma receptors. These have been linked with abnormal heart

function, mental disorders, and also with delirium.”

The US National Institute on Drug Abuse (NIDA) report in a Research Report Series

paper10 on cocaine states:

“While more research needs to be done, it is noteworthy that the mixture of cocaine and

alcohol is the most common two-drug combination that results in drug-related death.”

4

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

However cocaine-related health risks have a better recognition as a lone drug,

particularly in terms of the impact on the heart. Recent national  „Frank”Ÿ campaigns have

highlighted the risk to the heart in particular:

“Cocaine is highly risky for anybody with high blood pressure or a heart condition.

Perfectly healthy, young people can have a fit or heart attack after taking too much coke

and you may not know you”Ÿve got a pre-existing heart condition.” www.talktofrank.com

However the role of alcohol in the research behind cocaine harms is commonly

overlooked. A 2008 article in The Times called  „The New Cocaine Crisis”Ÿ11 reported that

A&E presentations of young revellers with heart problems had become so common they

had been labelled  „coke strokes”Ÿ by A&E staff. The article explores in particular the

frequency of cocaine-related Saturday night emergency admissions:

“The problem, though, is that getting high at weekends can put huge strain on the heart:

cocaine, in particular, constricts the blood vessels, raising blood pressure and making the

heart work harder. Throw in alcohol and amphetamines, and you have what some

doctors believe is a  „ticking time bomb of acute cardiac problems”Ÿ.”

3.2 Increased risk of violence?

The consequences of combined alcohol and cocaine use may not only be health related;

professionals point out that cocaine”Ÿs stimulant effect reduces a drinker”Ÿs feeling of

intoxication and allows greater quantities of alcohol to be consumed. Furthermore, with

the disinhibiting effect of alcohol combined with a heightened sense of self confidence

associated with cocaine, the links between increased violent or impulsive behaviour seem

logical.

Both alcohol and cocaine elevate extraneuronal dopamine and serotonin levels which in

turn may lead to deficits in impulse control and, thus, violent behaviour12. It is therefore

possible to hypothesise that the combination of alcohol and cocaine increases the risk of

violence than either drug taken alone. There is some research from the US that suggests

that combined alcohol and cocaine use increases the risk of violence (Chermack & Blow

200113; McDonald et al, 200814). In a separate review of the research evidence on

cocaethylene and violence, Penning et al. (2002) noted that:

“Retrospective research on violence suggests a major role for alcohol alone and additive

increases in violent behaviour or crime from the combination [with cocaine]. For ethical

reasons, high repeated doses of cocaine have not been studied experimentally. The

behavioural toxicity of highdose binge use of cocaine with alcohol may thus be

5

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

underestimated. One study shows a potentiation effect of the cocaine-alcohol

combination on the number of thoughts and threats of violence” 15

Volume 24 (March/April 2009) of Druglink magazine featured an article entitled  „The

hidden mixer”Ÿ16 exploring the possible link between combined alcohol and cocaine use

and violence. It reported that drug tests by Greater Manchester police had found that

„between a quarter and a third of people arrested for violence snorted powder cocaine

before fighting.”Ÿ However the article concluded that alcohol was still the most likely drug

affecting the risk of violent behaviour, and that personality is still the key determining

factor.

It has yet to be established exactly how and under what circumstances the combination

of alcohol and cocaine may give rise to increased risk of aggression and violence. There

is currently a shortage of in depth research which includes the role of important social

and contextual factors such as the night-time economy or domestic settings17. Further

exploration of combined use in violent offences could provide additional insight. Models of

data collection such as the Cardiff A&E data sharing model and initiatives such as alcohol

arrest referral schemes could be important opportunities to further explore risk factors

and prevalence relating to combined alcohol and cocaine use.

3.3 Addiction risks?

There appears to be insufficient research to assess whether combined cocaine and

alcohol use is likely to increase levels of addiction to either drug, or whether there is the

possibility of a particular habit-forming reaction to cocaethylene. A medical review of the

literature available on the psychological and somatic consequences of combined use

found no evidence that cocaethylene produced an enhanced addictive effect (McGowan,

2008). However one early study18 on cocaethylene concluded that  „The formation of

cocaethylene may play an important role in the systemic toxicity and abuse liability

associated with dual addiction to cocaine and alcohol.”Ÿ

Nonetheless, the already strong tendency of each drug to form a variety of physical and

psychological disorders without a combined synergy should not be overlooked. It has also

been suggested that  „some combined use can be explained by classical conditioning

theory. A combined user has their alcohol and cocaine use conditioned together so that

using one brings on the craving or desire to use the other.”Ÿ (McGowan, 2008). Anecdotal

reports also suggest that the  „crash”Ÿ or  „comedown”Ÿ effects of cocaine are reduced if

combined with alcohol, which may also be likely to lead to increased conditioning of poly-

use.

6

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

4. Use and prevalence of cocaethylene

Whilst medium to longer term trends of both cocaine and alcohol consumption have been

rising, there is little specific data available directly identifying cocaethylene prevalence.

However anecdotal reports suggest that many drinkers in the UK now see cocaine as an

integral part of their recreational alcohol use. A qualitative study19 of 34 young cocaine

users in London found that:

„Virtually everyone interviewed reported that they regularly drank alcohol when using

cocaine. Reports of drinking more heavily than usual while under the influence of cocaine

were widely described, with several reporting that they often drank at least twice their

usual alcohol intake. For a significant number of respondents, cocaine use was always

accompanied by alcohol. Some used cocaine to moderate the undesirable effects of

alcohol (such as feeling less in control and unsteady on their feet), so that they could

continue to drink. In contrast, others used alcohol in a functional way to moderate the

effects of cocaine: to help them take the edge off feelings of anxiety or paranoia and to

help them to sleep at the end of the evening. As Kate, an unemployed 22-year-old,

explained:

„I won”Ÿt have cocaine without alcohol. Because when you have cocaine on its own it”Ÿs a

completely different buzz. You can get on a paranoid buzz if you have it on its own. The

alcohol brings you on a level.”Ÿ (Kate, aged 22)

Overall, respondents reportedly recognised very few risks associated with using cocaine

and alcohol together.”Ÿ

@Prescripteur, j'ai pris le temps de traduire le texte en anglais et il y a des choses vraiment intéressantes.
Ils parlent bien de toutes les conséquences néfastes que cette substance peut avoir sur l'organisme, aussi bien au niveau des organes que au niveau du comportement.
A un moment donné ils disent que l'effet désinhibant de l'alcool conjugué à  un excès de confiance en soi dû à  la cocaïne, peut engendrer des comportements violents.......bah tu m'étonnes ! Il y a une majoration de l'impulsivité !
Les populations les plus à  risque de décéder sont celles qui ont une pression artérielle importante ou celles qui ont déjà  une fragilité/maladie du coeur.
Le seul point positif et non des moindres, c'est que le cocaéthylène augmente et prolonge les effets euphorisants.

@Mammon, si tu peux retrouver le thread, c'est cool, thanks.

Dernière modification par empathy (04 avril 2011 à  20:54)