The majority of research suggests that people who drink alcohol mixed with energy drinks (AmED) consume higher quantities of alcohol than non-AmED drinkers. This is then associated with an increase in behaviours with potentially very serious negative consequences, such as drink driving and unplanned unprotected sex.
The general assumption behind this link is that energy drinks might mask the intoxicating and impairing effects of alcohol. It’s very easy to say we would never have unprotected sex or drink and drive when we’re sober, but after a few drinks our inhibitions fall away, and we may feel carefree and invincible. If you also reduce the sedative effects of alcohol by consuming energy drinks, you’re going to feel more awake and perhaps less impaired (although you will still be impaired).
So AmED seems to be the perfect recipe for increased alcohol-related harm, and there have been reports of fatalities involving these beverages. There also seems to be a significant increase in energy drink consumption. At a European level, 30% of adults, 68% of adolescents (10 – 18yrs) and 18% of children (3-10yrs) consume energy drinks. There is a concern that as energy drinks become more popular in younger people, they may be more likely to carry on consuming AmEDs as they get older. Between 2007 and 2011 the number of emergency department admissions involving energy drink consumption in North America doubled. Up to 13% of those cases involved alcohol (approx. 2612 cases).
However, before there are calls to ban AmEDs it’s important to understand that the majority of this research is what’s known as “between subjects”. That is, we’re comparing those who drink AmEDs with people who don’t. It’s possible that people who choose to mix these drinks are naturally more likely to consume higher quantities of alcohol and suffer negative consequences. It’s fairly well-known that sensation and novelty seekers tend to be more risky drinkers and it makes sense that these people will be attracted to the stimulant effect of energy drinks so they can be “wide awake drunk”.
In a UK survey of university students, AmED drinkers were more likely to take illicit drugs and smoke, they started drinking regularly at a younger age than non-AmED drinkers, and they reported more alcohol-related negative effects. Focusing on alcohol-only consumption episodes, those who sometimes used AmEDs consumed more alcohol, drank alcohol more frequently, and binged on alcohol more often than respondents who didn’t consume AmEDs. However the survey also compared drinking episodes that did or did not involve energy drinks within just the AmED respondents. This showed something interesting: when these students mixed alcohol and energy drinks they usually consumed less alcohol than when they consumed alcohol without energy drinks. They also reported fewer drinking days, heavy drinking days (e.g. binges), and negative drinking consequences.
Although these findings highlight a need for more thorough research, it’s important to recognise that any harm associated with AmED may not just be about alcohol-related injury. For instance a single, standard Jägerbomb (25ml Jägermeister with half a can of energy drink) provides 25g sugar – around the same as a standard chocolate bar – 130 calories, and 41mg caffeine. A Jägerpint (five shots and enough energy drink to make up a pint) provides around 4.5 units of alcohol, over 600 calories, 101g sugar, and 134mg caffeine (a double espresso is about 125 mg of caffeine). Too much sugar and excessive calorie consumption has been associated with a range of health problems, such as obesity, diabetes and heart disease. Significant caffeine intake can cause a range of unpleasant side effects including vomiting, palpitations and sleep disturbances. There have been incidents of young adults suffering severe health problems from heavy AmED consumption.
So the important question, at least in terms of whether we need resources for AmED-targeted alcohol interventions, is “Does this behaviour lead to specific negative consequences that alcohol consumption without energy drinks doesn’t?”At the moment, the case is not compelling. In a synthesis of non-UK research, risk of injury was found to be associated with higher energy drink intake regardless of level of alcohol consumption, and risky drinkers were more likely to suffer alcohol-related harm irrespective of AmED use. That’s not to say there are no unique risks, but more appropriate research is needed to actually answer this question. At the moment the evidence is too messy, there’s no standardisation in terms of measuring quantity of alcohol consumption, degree or type of harm, ratio of alcohol to energy drink consumption, and most of the research is comparing different types of drinkers so causation simply can’t be determined.
As with most things, moderation is key and the potential risks associated with AmED need to be researched within the wider context of diet and other lifestyle choices.
Dr Abi Rose is a Senior Lecturer in Psychology at the University of Liverpool. Her research investigates the psychopharmacological basis of addiction and the impact of harmful alcohol use. She can be found on twitter @AbiRose9.
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