Typology of alcohol mixed with energy drink consumers: motivations for use

Alcohol and energy drinks: individual contribution of common ingredients on ethanol-induced behaviour

Since energy drinks (EDs) were sold to the general public as soft drinks and recreational beverages, mixing EDs with ethanol has grown in popularity, particularly among younger people. Given the research that links these drinks with higher risk behaviors and increased ethanol intake, ethanol combined with EDs (AmEDs) is a particularly worrying combination. EDs generally commonly include a variety of ingredients. Sugar, caffeine, taurine, and B-group vitamins are almost always present. Studies on the combined effect of ethanol and sugar and caffeine on ethanol-induced behaviors are extensive. Not so much in regards to taurine and vitamins. This review briefly summarises available information from research on the isolated compounds on EtOH-induced behaviors first, and secondly, the combination of AmEDs on EtOH effects. The conclusion is that additional research is needed to fully comprehend the characteristics and consequences of AmEDs on EtOH-induced behaviors.

Alcohol mixed energy drink usage and risk-taking among college students in Western New York State

Alcohol mixed energy drinks (AmED) may promote excessive alcohol intake and risk-taking among college students. Objective: To understand the relationship between AmED use and risky behavior as well as attitudes and motivations for AmED use. Participants: Undergraduate college students N = 422 (Study 1), N = 37 (Study 2). Methods: Using a mixed-methods approach, we first surveyed undergraduate students about their AmED and alcohol consumption and a series of risk behaviors, self-efficacy, and beliefs (Study 1). We then conducted focus groups within the same population to better understand attitudes, knowledge, and motivations for using AmED (Study 2). Results: Recent AmED use was significantly associated with an increased number of reported binge drinking occasions and self-reported driving while intoxicated events. Our qualitative data analyses revealed two major themes associated with AmED consumption: factors encouraging AmED use and decisions about driving while under the influence of alcohol. Conclusions: These findings add to the literature of beliefs and motivations for AmED use among college students.

Caffeine increases alcohol self-administration, an effect that is independent of dopamine D2 receptor function

The rising popularity of alcohol mixed with energy drinks (AmEDs) has become a significant public health concern, with AmED users reporting higher levels of alcohol intake than non-AmED users. One mechanism proposed to explain this heightened level of alcohol intake in AmED users is that the high levels of caffeine found in energy drinks may increase the positive reinforcing properties of alcohol, an effect that may be dependent on interactions between adenosine receptor signaling pathways and the dopamine D₂ receptor. Therefore, the purpose of the current study was to confirm whether caffeine does increase the positive reinforcing effects of alcohol using both fixed ratio (FR) and progressive ratio (PR) designs, and to investigate a potential role of the dopamine D₂ receptor to caffeine-induced increases in alcohol self-administration. Male Long-Evans rats were trained to self-administer a sweetened alcohol solution (10% v/v alcohol + 2% w/v sucrose) on an FR2 schedule of reinforcement, and the effects of caffeine (0, 5, 10, and 20 mg/kg, i. p. [intraperitoneally]) on the maintenance of alcohol self-administration and alcohol break point were examined. Parallel experiments in rats trained to self-administer sucrose (0.8% w/v) were conducted to determine whether caffeine's reinforcement-enhancing effects extended to a non-drug reinforcer. Caffeine pretreatment (5-10 mg/kg) significantly increased sweetened alcohol self-administration and motivation for a sweetened alcohol reinforcer. However, similar increases in self-administration of a non-drug reinforcer were not observed. Contrary to our hypothesis, the D₂ receptor antagonist eticlopride did not block a caffeine-induced increase in sweetened alcohol self-administration, nor did it alter caffeine-induced increases in motivation for a sweetened alcohol reinforcer. Taken together, these results support the hypothesis that caffeine increases the positive reinforcing effects of alcohol, which may explain caffeine-induced increases in alcohol intake. However, the reinforcement-enhancing effects of caffeine appear to be independent of D₂ receptor function.

Alcohol mixed with energy drinks: what about taurine?

RATIONALE

Since energy drinks (EDs) were marketed to the general public as recreational and soft drinks, mixing these with alcohol has become a popular practice, especially in the younger population. Alcohol mixed with EDs (AmEDs) is a particularly alarming combination, given the evidence that consistently associate these drinks with increased risk behaviours and greater alcohol consumption. Caffeine and taurine are commonly found in EDs. In contrast to caffeine, the studies on taurine psychoactive properties and how this amino acid influences ethanol intake alone or in combination with caffeine are not so numerous.

OBJECTIVES

We summarised relevant and available data on the studies focusing on taurine as a psychoactive agent and its influence on ethanol (EtOH)-induced behaviours. Given the increased risk that represents mixing alcohol with energy drinks, we put emphasis on the research exploring the impact of these combinations on motivated behaviour towards EtOH consumption.

RESULTS

The research on taurine properties on motivated behaviour towards EtOH consumption is limited, and mostly all done in combination with caffeine or other molecules. This makes it difficult to elucidate the effect of this amino acid when combined with alcohol.

CONCLUSIONS

Incomplete understanding of the properties and effects of AmEDs is unavoidable until more studies are performed on the influence of taurine on motivation to consume alcohol. Taurine should be further explored, particularly in regard to its potential beneficial applications, motivational properties and synergies with other psychoactive ingredients (i.e. caffeine).

Alcohol mixed with energy drink (AMED): A critical review and meta-analysis

The purpose of this systematic review and meta-analysis was to critically review the (1) prevalence of alcohol mixed with energy drink (AMED) consumption, (2) motives for AMED consumption, (3) correlates of AMED consumption, and (4) whether AMED consumption has an impact on (a) alcohol consumption, (b) subjective intoxication, and (c) risk-taking behavior. Overall a minority of the population consumes AMED, typically infrequently. Motives for AMED consumption are predominantly hedonistic and social. Meta-analyses revealed that AMED consumers drink significantly more alcohol than alcohol-only (AO) consumers. Within-subject comparisons restricted to AMED consumers revealed that alcohol consumption does not significantly differ between typical AMED and AO occasions. On past month heaviest drinking occasions, AMED users consume significantly less alcohol on AMED occasions when compared to AO occasions. AMED consumers experience significantly fewer negative consequences and risk-taking behavior on AMED occasions compared with AO occasions. Meta-analyses of subjective intoxication studies suggest that AMED consumption does not differentially affect subjective intoxication when compared to AO consumption. In conclusion, when compared to AO consumption, mixing alcohol with energy drink does not affect subjective intoxication and seems unlikely to increase total alcohol consumption, associated risk-taking behavior, nor other negative alcohol-related consequences. Further research may be necessary to fully reveal the effects of AMED.

Children and young people's perceptions of energy drinks: A qualitative study

BACKGROUND

Consumption of soft drinks is declining in many countries, yet energy drink sales continue to increase, particularly amongst young consumers. Little is currently known about the drivers behind these trends. Energy drinks are high in sugar and caffeine, and evidence indicates that regular or heavy use by under 18s is likely to be detrimental to health. This study aimed to explore children and young people's attitudes and perceptions in relation to energy drinks in a UK context.

METHODS

Eight focus groups were conducted with pupils aged 10-11 years (n = 20) and 13-14 years (n = 17) from four schools in northern England. A sub-sample also took part in a mapping exercise to generate further insights. Data were analysed using the constant comparative approach.

RESULTS

Energy drinks were reportedly consumed in a variety of public and private places, generally linked to social activities, sports and computer gaming (particularly amongst boys). Participants demonstrated strong brand awareness and preferences that were linked to taste and perceived value for money. The relatively low price of energy drinks and their widespread availability were identified as key factors, along with gendered branding and marketing. Some participants demonstrated a critical approach to manufacturers' claims and many were keen to become better informed, often through school- or peer-based interventions. Other potential interventions included age restrictions, voluntary schemes involving retailers and improved labelling.

CONCLUSIONS

The lack of a single dominant factor in participants' consumption choices suggests that there is unlikely to be a 'silver bullet' in attempting to address this issue. However, the findings provide support for policy-level interventions that seek to change the behaviours of manufacturers and retailers as well as consumers, and actively involve children and young people where possible.

Intoxication-Related Alcohol Mixed with Energy Drink Expectancies Scale: Initial Development and Validation

BACKGROUND

Young adult use of alcohol mixed with energy drinks (AmEDs) has been linked with elevated risks of a constellation of problem behaviors. These risks may be conditioned by expectancies regarding the effects of caffeine in conjunction with alcohol consumption. The aim of this study was to describe the construction and psychometric evaluation of the Intoxication-Related AmED Expectancies Scale (AmED_EXPI), 15 self-report items measuring beliefs about how the experience of AmED intoxication differs from the experience of noncaffeinated alcohol (NCA) intoxication.

METHODS

Scale development and testing were conducted using data from a U.S. national sample of 3,105 adolescents and emerging adults aged 13 to 25. Exploratory and confirmatory factor analyses were conducted to evaluate the factor structure and establish factor invariance across gender, age, and prior experience with AmED use. Cross-sectional and longitudinal analyses examining correlates of AmED use were used to assess construct and predictive validity.

RESULTS

In confirmatory factor analyses, fit indices for the hypothesized 4-factor structure (i.e., Intoxication Management [IM], Alertness [AL], Sociability [SO], and Jitters [JT]) revealed a moderately good fit to the data. Together, these factors accounted for 75.3% of total variance. The factor structure was stable across male/female, teen/young adult, and AmED experience/no experience subgroups. The resultant unit-weighted subscales showed strong internal consistency and satisfactory convergent validity. Baseline scores on the IM, SO, and JT subscales predicted changes in AmED use over a subsequent 3-month period.

CONCLUSIONS

The AmED_EXPI appears to be a reliable and valid tool for measuring expectancies about the effects of caffeine during alcohol intoxication.

Environmental contexts of combined alcohol and energy drink use: Associations with intoxication in licensed venues

BACKGROUND

Environmental factors inside licensed venues have been found to influence the intoxication levels and consumption practices of patrons. The consumption of alcohol mixed with energy drinks (AmED) occurs primarily at or prior to attending licensed venues, however there is a lack of in situ research investigating AmED use in these contexts. Given that AmED use has been linked with increased alcohol consumption, intoxication, illicit substance use, and risk taking behaviours, this paper explores the environmental correlates and levels of intoxication associated with AmED use in licensed venues.

METHODS

Structured observations were undertaken in five Australian cities on Friday and Saturday nights. Covert teams spent 4-5h in venues and recorded hourly observations on patron, venue, and staff characteristics, alcohol, illicit drug and AmED consumption patterns and intoxication levels.

RESULTS

898 hourly observations were recorded across 68 venues. All but one venue served energy drinks, and patron AmED use was observed during 34.9% of hourly records. AmED use was more prevalent after 12am and in nightclub venues compared to bars and pubs, and was positively associated with high intoxication levels, illicit drug use, and younger crowds. After controlling for environmental factors (i.e. venue crowding, service practices, venue characteristics, patron demographics and behaviour) AmED use did not predict high intoxication at a venue level in multivariable models.

CONCLUSION

AmED consumption is ubiquitous in the licensed venues of Australian night-time entertainment districts, particularly busy nightclub venues where intoxication and risky consumption are heightened. However, AmED use was not associated with high patron intoxication when environmental factors were considered.

Alcohol Mixed with Energy Drink Use as an Event-Level Predictor of Physical and Verbal Aggression in Bar Conflicts

BACKGROUND

Young adult use of alcohol mixed with caffeinated energy drinks (AmEDs) has been globally linked with increased odds of interpersonal aggression, compared with the use of alcohol alone. However, no prior research has linked these behaviors at the event level in bar drinking situations. The present study assessed whether AmED use is associated with the perpetration of verbal and physical aggression in bar conflicts at the event level.

METHODS

In Fall 2014, a community sample of 175 young adult AmED users (55% female) completed a web survey describing a recent conflict experienced while drinking in a bar. Use of both AmED and non-AmED alcoholic drinks in the incident were assessed, allowing calculation of our main predictor variable, the proportion of AmEDs consumed (AmED/total drinks consumed). To measure perpetration of aggression, participants reported on the occurrence of 6 verbal and 6 physical acts during the bar conflict incident.

RESULTS

Linear regression analyses showed that the proportion of AmEDs consumed predicted scores for perpetration of both verbal aggression (β = 0.16, p < 0.05) and physical aggression (β = 0.19, p < 0.01) after controlling for gender, age, sensation-seeking and aggressive personality traits, aggressive alcohol expectancies, aggressogenic physical and social bar environments, and total number of drinks.

CONCLUSIONS

Results of this study suggest that in alcohol-related bar conflicts, higher levels of young adult AmED use are associated with higher levels of aggression perpetration than alcohol use alone and that the elevated risk is not attributable to individual differences between AmED users and nonusers or to contextual differences in bar drinking settings. While future research is needed to identify motivations, dosages, and sequencing issues associated with AmED use, these beverages should be considered a potential risk factor in the escalation of aggressive bar conflicts.