Stemming from the user experience, the analysis begins with a brief look at participants relationship to MDMA, then pivots to an exploration of their relationship to cocaine and how they attempt to balance the risks and harms of this more popular choice. Then we establish the reasons why this harm reduction choice should be more critically examined, as cocaine more than MDMA, is perceived by participants as a common and acceptable, low-risk drug. Exposure to harm appears when we examine the increase in co-consumption with alcohol and negative feelings that participants report as a result from this harm reduction practice.
Situated MDMA use
While participants had experience with a variety of drugs, the interest of this paper is on their relationship with three commonly used recreational drugs: MDMA/ecstasy, cocaine, and alcohol. After cannabis, MDMA was the second most used illicit drug among participants, 27 out of 31 (87%) had used it. They enjoyed MDMA when they went out “raving” or “to a festival or club night.” Notably, they did not use MDMA “at the pub or sitting at home” or while “just having a few drinks.” As Jeff (23) succinctly expressed, “I wouldn’t go to the pub and have a big drinking session and take MDMA, it’s more for a bit of coke.” This supports the view that MDMA is an event-based drug (24): its planned use typically pivots around events such as raves, club nights, and festivals and importantly, not around drinking sessions or other alcohol focused events and spaces. As young adults grow out of the above scenes where MDMA is commonly used, their use of it also decreases (25). Natalie (23) pointed out one of the ways in which MDMA and pubs are incompatible:
If you were taking MD[MA] in a pub, it would just be, you know what I mean, it's a bit, I mean some people might frown upon taking coke in a pub, but it's more of a… you can still be sociable and normal with people that aren't taking cocaine.
Frasier (24) agreed and emphasized that one’s appearance and behavior makes cocaine use, not MDMA, normal and popular at a bar: “You can tell if someone is quite high on [cocaine] but you can more blend into a drunk crowd. Whereas I don’t think if you are on MDMA you could blend into a drunk crowd.” Here, Frasier alludes to the visible grinding of teeth that would seem out of place in a bar.
Another sign of maturing came from Joseph (23), who saw regular MDMA use as unsustainable. He explained why he used it only sporadically, a view shared by his peers:
There wouldn’t be a single day where I would be like, after I’ve done MD[MA], the next day would I be like, ‘I want to do MD[MA] again.’ Never has that ever happened to me because I’m coming down, I’ve depleted all my serotonin, I feel like shit.
Joseph consciously leaves several months between sessions to allow his serotonin levels to replenish, reflecting an understanding and embodiment of harm reduction for MDMA use (26).
Participants had positive things to say about using MDMA. For some, it was one of the “best things they’ve ever done”:
I’d say MDMA is probably the most influential event in my entire life. I think it changed me pretty radically into a different person for the better. Looking back, I never truly empathized with anyone else, right to the core, you know, to the soul if you will, and MDMA allowed me to do that for the first time. (MacMillian, 23)
Jesse (22) emphasized the transformative effect of MDMA: “…I didn’t realize that drugs did that to you. Like cocaine is good fun, but it’s not like, it doesn’t bring you a raw emotion like [MDMA] does.” Jeff (23) had a similar experience and compared the effects of MDMA to those of cocaine: “…euphoric highs, self-described, isn’t it? Yeah, sort of similar to what I said about cocaine, nice feeling, more energy.” While it is undeniable that these participants had positive experiences with MDMA, the same individuals had significantly fewer positive associations with cocaine, a drug they used much more frequently.
The appeal of cocaine
Cocaine powder was the third most used illicit substance among participants, with 24 out of 31 (78%) having used it. Participants snorted cocaine with friends and strangers alike, indicating that cocaine was a social, not solitary, activity. Relatedly, none of the participants had ever used cocaine on their own, further evidence that drug use is a social and ritualized practice that bonds young people to their peers (27). There was no uniform moment when cocaine was first used, some had their first experience in high school, some later at university, and others once they had joined the workforce.
Participants reporting using cocaine at home, at parties, and at after-work drinks, in dorms, pubs, bars, clubs, and recording studios. Wherever drinking alcohol was accepted, cocaine was present, supporting the idea that cocaine and alcohol are closely intertwined. This is important as bars and pubs were the most popular places for participants to socialize: the place to watch football or eat a meal or act as the meeting point to begin a night of pub-hopping – confirming pubs and bars as fixtures in the lifestyles of British youth and beyond (28).
Resulting from a thematic analysis, participants’ reasons to use cocaine can be understood by four motivations. The first is spontaneity/curiosity (“That’s the only reason I tried [cocaine] in the first place, I was like, ‘Well I haven’t tried it.’ Obviously, I know it’s a bad thing, I mean drugs are bad, but, um, yeah, I guess, I just really thought, ‘Fuck it, why not?’” Azealia, 22). The second is to gain confidence/connect with people (“You literally feel like you can go up and talk to anyone” Dean, 23). The third is to gain energy/stay awake (“I’d use it mainly at the end of the night, I guess, when I’m on a bit of a comedown from MD[MA], or kind of finish a festival and get home” Kiera, 22). The fourth is to sober up/continue drinking. Using cocaine to combat the depressing effects of alcohol and to “boost [you] through the evening” (Dexter, 22) is of particular interest here as it indicates a potentially dependent cycle of poly-drug use. Jesse (22) relied on the stimulating effects of cocaine to allow him to continue drinking, particularly if he had already drunk too much: “Coke, I keep as a little top up, it saves me.” Others, like Dexter and Jesse, disclosing that their cocaine use is almost always motivated by their alcohol use signals a strong pattern of co-consumption, a behaviour that will be examined for its unintended risks later on.
Reducing Harm?
Since all participants who had used cocaine had also used MDMA, it was natural for them to draw comparisons between the highs and lows of the two drugs in an attempt to achieve a desired effect of their drug use. Dean (23) explained the overlapping effects of MDMA and cocaine:
…cocaine is sort of similar to MD[MA] in a way, in that you feel it sort of takes down barriers or filters in your mind. Whereas you’d normally sort of have filters like, “Should I say that?” or something like that, but with MD[MA] and coke, it just takes away that filter and you become very confident with no inhibitions and just enjoying yourself.
Participants pointed to similarities and differences in their experiences with cocaine and MDMA. Cocaine is like MDMA but “without all the baggage” and gets you “a little higher up but you can keep your jaw still,” making it “a bit [of an] easier choice.” The ‘baggage’ to avoid is the depletion of serotonin associated with comedowns, the nausea associated with ‘peaking’ on ecstasy, bruxism or teeth grinding, and concerns about the quality of pills. In light of these issues, many viewed cocaine as providing a more manageable high than MDMA.
I’d been offered coke and coke didn’t make me like, as nuts as MDMA did. I didn’t seem to get as bad comedowns, I didn’t chew off my face. It still gave you the pretty good high but didn’t have the sort of dirty side effects of MDMA. (Declan, 23)
I had [cocaine] and I actually enjoyed it far more than I did ecstasy and that was sort of the point where I completely stopped doing ecstasy, in like, it wasn't the drug to do if I was at a party. It started becoming cocaine, it wasn't seen as aggressive and like, your head’s not all over the place as with ecstasy. So that's how I switched from one to the other. (Adam, 22)
Some of the drugs are a bit easier to take more regularly than the others. I wouldn't be able to do pills [MDMA] every weekend cos I feel like it affects me, I feel burnt out for like three, four days, so if I was doing that every weekend, it would ruin me. I feel like, coke you might feel a little bit shitty the next day or feel a bit rough, but I don’t feel like it’s that long lasting with side effects. (Nicky, 22)
Natalie (23) enjoyed the sense of control cocaine gave her although she admitted that the loss of control she experienced with MDMA had some appeal: “I see [MDMA] as sort of, you are going to get a bit, you know, loose, whereas with coke, I feel like you are sort of still with it? Not as fun to be fair.”
Cocaine was seen as less disruptive to everyday routines than MDMA; it could be integrated more fluidly in the spaces where participants socialized. Cocaine helped to lubricate their social lives and had the added benefit of helping them to stay awake and be with friends for longer. Another reason cocaine was seen as less harmful was that drug sellers would sometimes mention purity levels when selling it, perhaps giving the illusion that the powder had already been tested and thus giving buyers a false sense of safety.
The above examples of participants shifting from MDMA to cocaine point to a form of harm reduction. In light of their personal experiences, they weighed the pleasures and risks of both drugs and concluded that cocaine has fewer undesirable effects. However, in their attempts to balance risk and pleasure associated with their cocaine use, they are confronted with unforeseen risks particularly when we consider the lived effects of this practice. Unlike MDMA, participants did not treat cocaine as a drug for events; it was used more regularly, more spontaneously, and more recreationally. This insight is supported by two observations: cocaine is ubiquitous in youths’ nightlife and is perceived as a low-risk drug. This understanding provides a foundation for examining the challenges of this balancing act: the unexpected risks of the frequent and cyclical relationship of the co-consumption of cocaine and alcohol that develops out of participants’ quest for a less harmful high.
Ubiquitous in young adults’ nightlife
All participants expressed that cocaine is ubiquitous and normalized within their social circles. This shared understanding was present with all participants regardless of how often they use cocaine. As an infrequent user, Angel (22) disclosed:
I’m not really motivated to do [cocaine]. I’ve never gone out with a plan that I was going to do coke at a party or a night out. Sometimes it’s just, if there are a few people doing it, then you do it as well, and it’s a bit of fun, but it’s not like…I guess that’s, yeah, that’s the one I would say I enjoy the least, mostly because it makes me feel shit in the morning.
Angel disinterest in using cocaine but doing so anyway for “a bit of fun,” even when he knows he will feel bad the next day is disconcerting, albeit a practice held by many. Jesse (22), who uses cocaine regularly, explained that when he felt the need to take a break from his regular cocaine use, he would not buy it. But since cocaine is omnipresent in his peer group, his choice to not buy it did not affect its availability; it would inevitably appear and he would often not be able to resist.
Sometimes I've not planned to do [cocaine] but then end up doing it anyway, but like, yeah, it's not, I don't know… it's good sometimes when everyone else is on it. A lot of my friends do it as well, it's not like I'm peer pressured into doing it, it’s just like, it's there and I want to do it as well, cos like, I don't want to be the one [not to], cos they're annoying and then I'm just tired.
The self-reflection in Jesse’s choice to take a break from using cocaine, and that he often fails to stick to his intentions, speaks to the complexities of co-consumption and how entrenched cocaine has become in participants’ social lives. Cocaine was not only present and normalized in participants’ peer groups, but in the spaces where they socialized. In bars and pubs, cocaine, more than any other drug, was the drug to use and/or come across.
But usually, if we're going on a big night and we're at the pub, that's usually where everybody else is, like, getting coke. (Kiera, 23)
But these days, if I’m going to go to the pub, then coke is the option. (Adrian, 23)
I mean, coke just became an association with [going] drinking. (Mortimer, 23)
While the above statements suggest that cocaine is normalized in spaces associated with recreation, a few participants shared stories of cocaine use being socially acceptable in spaces rarely associated with pleasure, namely the workplace. Tim (23) described how he was introduced to cocaine by his colleagues at a recruitment agency at their office Christmas party. As the new hire, he felt pressured to join his colleagues, which resulted in a “Wolf of Wall Street type bender.” Declan (23) used cocaine heavily throughout university, mostly for recreation. However, he recounted one bar shift on December 31st that began with his boss inviting staff to help themselves to lines of cocaine in the staffroom as a gift and aid for working the busy New Year’s Eve shift, suggesting that this drug serves multiple purposes – pleasure and function – reaffirming its’ acceptability in multiple spaces.
Perceived low-risk
Cocaine has several properties that make it a fitting drug to be used recreationally. It does not typically require much preparation or planning; one does not need to set aside time to experience cocaine’s short and immediate effects. While participants mentioned using at-home drug purity testing kits for MDMA, no one had ever tested their cocaine. This suggests that participants do not see it as necessary, that cocaine has less chance of being contaminated. This also fuels the idea that cocaine is “easy to use.” Its brief high and instant reward is an appealing alternative to a longer and energy-consuming high of MDMA. Participants could rely on cocaine to elevate their normal feelings; they knew they were not going to disconnect from reality or disassociate. Instead, they would become more “with it,” thus making it the more appealing – and often spontaneous – choice.
Cocaine powder was reported easy to dose. While participants expressed fears about overdosing on alcohol, ketamine, LSD, cannabis, and MDMA, not one participant expressed concerns about overdosing on cocaine. Similarly, while accurate measurements of doses for many drugs was important, Jeff (23) for example, preferred to ‘eyeball’ approach to a line: “you’d be more aware of your dosage [with ketamine] rather than with cocaine, if you have a bigger line, it’s not really going to change too much.”
Another sentiment shared by participants was that “you don’t really say no to free coke.” Participants understood that, for their student budgets, cocaine is expensive. If anyone from or outside of their social circle offered them cocaine, regardless of whether they wanted it or had planned for it, they would generally accept the invitation to get high for free. Such spontaneous use points to cocaine being seen as a ‘non-committal’ drug – one can go to a pub and accept a line from someone without planning it, and this can have minimal impact on them, their actions, or the trajectory of their evening. Cocaine flows casually through social circles and drinking spaces, and can be accessed easily and spontaneously, regardless of (prior) intention. This sentiment, and cocaine being seen as a low-risk drug, are captured in Kaitlin’s description of its prevalence, and how casually she describes her decision to take it:
…someone always has it, like, it doesn’t matter if you go out and think, “No, I’m not going to do any,” someone always comes to you like, “Oh, you want a line?” “Well, yeah, ok, alright.” (Kaitlin, 22)
Co-consumption of alcohol and cocaine
Alcohol and cocaine are often used in the same space, leading to overlapping use. Although one is licit and the other illicit, both are easily accessible, perceived low-threshold, low-risk drugs.
Their use is moreover compatible: the stimulating effects of cocaine complement the depressing effects of alcohol (29). Additionally, cocaine helps one to sober up, while alcohol lowers inhibitions. Drinking can lead to unintended behavior which, can include the increased and/or unplanned use of cocaine.
The relationship of poly-drug use has been examined elsewhere by Nichter et al (30), whose writing on the co-consumption of tobacco and alcohol highlights a strong association between two legal substances. They suggest that on its own, tobacco is a highly stigmatized substance but when used together with alcohol, its use is normalized, acceptable, and seen as ‘a packaged deal.’ The analysis on participant co-consumption patterns that follows draws upon that insight, but instead focuses on cocaine’s considerable increase in acceptability within the backdrop of alcohol consumption and drinking spaces. We now zoom in on the particulars of this relationship and the interaction of the two drugs to arrive at an understanding that participants harm reduction practice of shifting away from MDMA use in favour of cocaine is producing additional risks.
Excessive consumption of alcohol is associated with sloppiness, aggression, and memory loss. Participants often used cocaine to overcome these negative effects of alcohol: “Coke keeps you from getting too drunk, which is good” (Jesse, 22). Cocaine also helped them to sober up so that they could either continue drinking or not become a ‘sloppy drunk’: “You can drink loads and you go out and you think you’re sober but you’re not. But you’re doing less mad stuff than if you were just drunk” (Jesse, 22). Snorting cocaine becomes a way to reduce the harms of drinking, something that Jesse learned at age 14.
I was at my brother’s house and his mates were round and I was drinking with them, but I didn't realize what they were doing, cos they were drinking loads and not getting drunk and I was getting really drunk. And I went to the toilet and I was throwing up and his mate walked in and was like, "Oh, crap," and he was like, "Do you want some?" And I said, "What is it?" And he said, "It wakes you up a bit." I knew what it was, yeah, and I thought “Should I do it?” And I'd seen it in films and things like that. I tried it and I felt like Super Mario, you know, when he takes the gold star thing, yeah. I felt tired and ill [before] and then after that, I was like, “Woah.” My brother beat him up though, cos he was like, "You shouldn't be giving my brother..." But he helped me out, so.
Jesse views his cocaine use as "serv[ing] a function” when he’s been drinking. He elaborates:
If I'm out and I'm getting a bit tired, I'd do some cocaine. If I know I've got a really big night out, cos coke makes you, you don't get as drunk. And like, you can drink more and not get as sick if you drink too much. Cos now I've done it before, like, you drink the same amount before having used cocaine but then you get to the point where you're like, ‘Ok, I need some now or I'm going to be fucked in a minute.’
While this may hint at the efficacy of cocaine to sober up, it also shows that Jesse’s use of the powder to mitigate the harms of alcohol has made him reliant on the drug. He doesn’t necessarily use cocaine for pleasure; it has become “like a little safety net” for his drinking. Jesse continues, exposing the dependent nature of this cycle:
If you drink too much, you fall into a state and you can't move, so when you feel that happening, that’s what it’s there for… it just stops me from getting too messed up. But then once you've had a little bit, you want more of it, so.
The experiences of Kaitlyn (22), likewise hint at reliance – of how the intoxicating effects of alcohol and cocaine together have the potential to fuel a co-dependent relationship.
Ahh, highly addictive, once you start, you can’t… I started taking it when I was drinking and it sobers you up. Then it just becomes like, your everyday, like, as soon as you have more drink than you can handle, it’s like, “Ok, let’s get some coke and drink some more!”
Although Natalie (23) was aware that her drinking was negatively affecting her memory, she chose to use cocaine to temporarily improve the situation rather than address her alcohol use: “But the one thing with coke is, if I take coke, I will remember my night for some reason. If I drink, I’ll often have black out bits, so I guess that’s a positive in a way, cos I’ll remember everything that happened.”
These excerpts suggest that when young people take cocaine to negate the unwanted effects of alcohol, they are doing so with ‘good intentions’: it helps them to reduce the social and physical risks associated with drunkenness. They are aware of the risks of excessive alcohol consumption, like drunkenness, and balance this out with cocaine’s sobering effect. This well-established balancing act of tinkering with ‘uppers’ and ‘downers’ is common place with poly-drug use (31) however what seems to be absent from these narratives is the awareness of what other risks arises from this attempt to balance risk and harm.
The excerpts also reveal that intoxication often leads to spontaneous decision-making. Regardless of their intentions, participants would often find themselves buying or accepting offers of cocaine after having consumed alcohol, pointing to alcohol’s potential to lead to poly-drug use. As Natalie (23) admits, “it would be a last-minute silly decision after a few drinks like, ‘Yeah, it'd be a good idea to get some coke.’” Although Natalie makes this sound harmless, lowered inhibitions in spaces where cocaine is present and normalized had serious consequences for participants’ well-being.
Participants identified alcohol to be the substance they have the most challenging relationship with. For example, Jesse (22) states: “I don’t like to not have a drink in my hand. Alcohol is the main problem, I think. I mean the other stuff [cocaine] just comes with it.” What stands out in Jesse’s story, and those of his peers, is that the substance and behavior they most want to get under control is alcohol and drinking – often the catalyst for their cocaine use. Paradoxically, drinking is rarely understood as a risky activity, “but rather as an almost essential activity that features as an integral and unquestioned part of being young” (27).
The stories of co-consuming alcohol and cocaine suggest a cycle of reliance on both substances. Participants’ relationship with cocaine was further explored by looking at the lived effects of this co-consumption, how this route to address the unwanted effects of alcohol negatively impacted on their well-being. The stories also contain possible warning signs of dependency.
Negative experiences with cocaine
A key finding of this study is that participants continued to use cocaine, even when their enjoyment of it had waned. They were asked about their motivations to use cocaine and how they felt after they used it. Their responses generally ranged from indifferent to negative, while they expressed feelings of detachment, guilt, and remorse in connection to their cocaine use. These negative feelings were felt most strongly the following day, although some indicated that feelings of emptiness and disconnect persisted.
With MD[MA] I think I quite enjoy the feelings it gives me. With coke I didn’t really get that, I just felt quite rush-y and I felt quite disconnected from myself…. I think it was an escape for me. (Kiera, 22)
I feel very guilty when I do cocaine now. I don’t actually enjoy it, I actually wake up the next day and I think, “I never want to do that again, why did I do that? I can’t get to sleep and it’s six in the morning.” (Natalie, 23)
Cocaine hasn’t enriched [my life] a lot, really. I don’t really like cocaine as much, to be honest... But yeah, the reason I don’t like it as much is because often afterwards, I think, “Was there a need to have it?” But I always end up getting it anyway. It’s always good at the time, but as soon as you run out, you’re just sort of empty. (Jeff, 23)
Jeff admitted that while he continues to use cocaine because “it’s good at the time,” alluding to alcohol’s influence on his decision, he struggles to see this behavior as pleasurable and questions whether his actions are having a positive impact on his life.
Tom (23), a weekly cocaine user, reflected on the negative aspects of his cocaine use: “It’s expensive, so I’ve probably bought it before when I couldn’t afford it. And then, just being of a bit of cringe, just talking a lot, and waking up feeling a bit embarrassed. It obviously makes me feel anxious the next day, a lot of the time.” Tom could not point to anything positive arising from his weekly habit: “I just can’t think if I’ve actually gained anything out of it. Nothing is really benefited from it.” Strikingly, both Jeff and Tom used cocaine recreationally without much enthusiasm while reporting significant short and long-term negative effects. Jesse (22) reported something similar, but his words suggest something bleaker:
There are times when I am doing [cocaine] that it is not like affecting us anymore, but we are just doing it to not come down. To stay awake. When it gets like that, it’s a bit like, “What the fuck am I doing?” But it’s the darkest one, where you get like the worst thoughts from them than any of the others.
In these moments, Jesse uses cocaine not because it allows him to feel something positive, but “to not come down,” indicating that he is aware of the negative feelings that await but does not want to face them. Klaas (23) echoes that his continued use of the drug is driven by avoiding the negative effects of a comedown that await: “I take more because I don’t want to come off the drug”. Viewed in this light, their cocaine use not only lacks the positive effects it once had but fuels their negative thoughts on their practices and lifestyles.
These experiences prompt us to consider why, with so many negative emotions tied to regular use, these participants continue to see their cocaine use as harmless. A possible answer is dependency. Both cocaine and alcohol have a high potential for dependency-like behaviours to develop (32)(33). Although some participants had what seemed to be a problematic relationship with cocaine and/or alcohol, none stated that they were dependent on either. But in light of the practices noted above, this possibility should not be overlooked.
Finally, participants’ emphasis on how both their cocaine use and co-consumption practices are negatively affecting them psychologically is noteworthy as it accurately reflects young people who use drugs particular concerns, elements useful for effective harm reduction messaging.