Alcohol mixed with energy drinks: Are there associated negative consequences beyond hazardous drinking in college students?

Objective

The consumption of alcohol mixed with energy drinks (AmED) is prevalent among college students as is hazardous drinking, a drinking pattern that places one at risk for alcohol-related harm. The present study, therefore, examined associations between AmED use, hazardous drinking, and alcohol-related consequences in college students.

Methods

Based on a probability sample conducted in 2010, participants were 606 undergraduate students aged 18–25. AmED consumption included lifetime and past year use. Hazardous drinking and alcohol-related consequences were measured during the past year. Point prevalence was used to estimate rates of AmED use, and chi-square, ANOVA, and logistic regression were used to examine associations between AmED use, hazardous drinking, and alcohol-related consequences.

Results

Lifetime and past year AmED use prevalence rates were 75.2% and 64.7%, respectively. Hazardous drinkers who engaged in AmED use were significantly more likely than past year hazardous drinkers who did not engage in AmED use to have had unprotected sex (OR = 2.35, CI 1.27–4.32).

Conclusions

AmED use appears to be highly prevalent among college students, and AmED use may confer additional risk for unprotected sex beyond hazardous drinking. Unprotected sex has implications for public health, and students who drink hazardously and consume AmED may be at greater risk.     

Phone-delivered brief motivational interventions for mandated college students delivered during the summer months

Objective

Across the United States, tens of thousands of college students are mandated to receive an alcohol intervention following an alcohol policy violation. Telephone interventions may be an efficient method to provide mandated students with an intervention, especially when they are away from campus during summer vacation. However, little is known about the utility of telephone-delivered brief motivational interventions.

Method

Participants in the study (N = 57) were college students mandated to attend an alcohol program following a campus-based alcohol citation. Participants were randomized to a brief motivational phone intervention (pBMI) (n = 36) or assessment only (n = 21). Ten participants (27.8%) randomized to the pBMI did not complete the intervention. Follow-up assessments were conducted 3, 6, and 9 months post-intervention.

Results

Results indicated the pBMI significantly reduced the number of alcohol-related problems compared to the assessment-only group. Participants who did not complete the pBMI appeared to be lighter drinkers at baseline and randomization, suggesting the presence of alternate influences on alcohol-related problems.

Conclusion

Phone BMIs may be an efficient and cost-effective method to reduce harms associated with alcohol use by heavy-drinking mandated students during the summer months.     

Drinking at European universities? A review of students' alcohol use

Background

High volumes of alcohol consumption and risky single occasion drinking (RSOD) among university students have been shown to be associated with considerable harm to both those who consume alcohol and their fellow students. The vast majority of these studies are based on US and Canadian samples.

Aim

The present article provides an overview of the characteristics of alcohol-consuming university students in Europe.

Method

65 relevant articles published within the last 20 years using European student populations could be identified.

Results

Sociodemographic, individual, social, and university-related characteristics associated with alcohol consumption patterns could be identified. Male students, in particular, tended to consume alcohol more often and in higher quantities, including RSOD. Students consumed alcohol chiefly during social gatherings and for social and enhancement motives. Those without family obligations and those living alone, with roommates or in areas with a high density of students were more likely to consume alcohol in higher quantities, and to engage in RSOD. Students tend to overestimate the extent of their fellow students' alcohol consumption.

Conclusions

Health promotion and prevention efforts which focus on these characteristics (i.e., gender, drinking motives, living conditions and social norms), and which have been successful and evaluated among university students in the US and Canada, may also be very promising for their European counterparts.     

Effects of caffeinated vs. non-caffeinated alcoholic beverage on next-day hangover incidence and severity,perceived sleep quality,and alertness

Aims

Beliefs about the effects of mixing caffeine and alcohol on hangover or sleep may play a role in motivation to consume these mixtures; therefore, information is needed about actual effects. We investigated whether intoxication with caffeinated vs. non-caffeinated beer differentially affected perceived sleep quality, sleepiness, and hangover incidence and severity the next morning.

Methods

University students (89%) and recent graduate drinkers were randomized to receive: (1) beer with the equivalent of 69 mg caffeine/12 oz glass of regular beer (n = 28) or (2) beer without caffeine (n = 36), in sufficient quantity to attain a BrAC of 0.12 g%. After an 8-h supervised sleep period, participants completed measures of hangover, sleep quality, sleep latency and time asleep, and sleepiness.

Results

While caffeinated beer improved perceived sleep quality, effect sizes were greater for morning alertness than for quality while sleeping, with no effect on sleep latency or total sleep time. No effects were seen on hangover incidence or severity.

Conclusions

Mixing caffeine and alcohol does not significantly impair amount of sleep or sleep latency, hangover, or sleepiness the morning after drinking to intoxication in this population.     

Implicit alcohol cognitions in risky drinking nicotine users with and without co-morbid major depressive disorder

Objective

Alcohol consumption, nicotine use, and major depressive disorder (MDD) are highly co-morbid. The negative reinforcement model of addiction would suggest that smokers may consume alcohol to relieve negative affective symptoms, such as those associated with MDD and withdrawal from nicotine. Over time, these behaviors may become so strongly paired together that they automatically activate a desire to use alcohol, even in the absence of conscious or deliberate intention. This study examined implicit alcohol cognitions in 146 risky drinking nicotine users (n = 83) and non-users (n = 63), to help uncover cognitive mechanisms that link drinking, nicotine use, and depression together. We proposed that nicotine users with a history of MDD would have stronger implicit motivations to drink than non-nicotine users without MDD.

Method

Participants were assessed on lifetime MDD (n = 84) or no MDD (n = 62), and then completed an Implicit Association Task designed to test the strength of associations between alcohol pictures and “approach” words.

Results

Regression analyses showed that implicit alcohol–approach attitudes were stronger among risky drinking nicotine users than non-users. Alcohol–approach motivations were also stronger among risky drinking nicotine users compared to non-users with a history of MDD; nicotine use was unrelated to implicit alcohol cognitions for risky drinkers without MDD.

Conclusions

Implicit cognitive processes may be targeted in behavioral and pharmacological treatments in risky drinking nicotine users, particularly those with depression comorbidity.     

Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons

Aim

To assess event-level associations between energy drink consumption, alcohol intoxication, and intention to drive a motor vehicle in patrons exiting bars at night.

Method

Alcohol field study. Data collected in a U.S. college bar district from 802 randomly selected and self-selected patrons. Anonymous interview and survey data were obtained as well as breath alcohol concentration (BrAC) readings.

Results

Results from logistic regression models revealed that patrons who had consumed alcohol mixed with energy drinks were at a 3-fold increased risk of leaving a bar highly intoxicated (BrAC ≥ 0.08 g/210 L), as well as a 4-fold increased risk of intending to drive upon leaving the bar district, compared to other drinking patrons who did not consume alcoholic beverages mixed with energy drinks.

Discussion

These event-level associations provide additional evidence that energy drink consumption by young adults at bars is a marker for elevated involvement in nighttime risk-taking behavior. Further field research is needed to develop sound regulatory policy on alcohol/energy drink sales practices of on-premise establishments.     

The use of caffeinated alcoholic beverages among underage drinkers: Results of a national survey

Objective

The mixing of alcoholic beverages with caffeine has been identified as a public health problem among college students; however, little is known about the consumption of such drinks among younger adolescents. We estimated the prevalence of caffeinated alcoholic beverage (CAB) use among a wide age range of underage drinkers, examined differences in traditional (i.e. self-mixed alcoholic beverages with soda, coffee and tea) and non-traditional CAB use (pre-mixed caffeinated alcoholic beverages or self-mixed alcoholic beverages with energy drinks or energy shots) among underage drinkers by age and other demographic characteristics, and examined differences in hazardous drinking behavior between CAB and non-CAB users.

Methods

We used an existing Internet panel maintained by Knowledge Networks, Inc. to assess the use of pre-mixed and self-mixed CABs in the past 30 days among a national sample of 1031 youth drinkers age 13–20. We conducted logistic regression analyses to estimate the relationship between traditional and non-traditional CAB use and risky drinking behavior as well as adverse outcomes of drinking, while controlling for age, gender, race/ethnicity, income, and general risk-taking (seat belt use).

Results

The overall prevalence of CAB use in the sample of underage drinkers was 52.4% (95% confidence interval [CI], 47.4%–57.4%). CAB prevalence was 48.4% among 13–15 year-old drinkers, 45.3% among 16–18 year-old drinkers, and 58.4% among 19–20 year-old drinkers. After controlling for other variables, we found a continuum of risk with non-traditional CAB use most significantly associated with binge drinking (odds ratio [OR] = 6.3), fighting (OR = 4.4), and alcohol-related injuries (OR = 5.6).

Conclusions

The problem of caffeinated alcoholic beverage use is not restricted to college-aged youth. The prevalence of CAB use among underage drinkers is higher than previously thought and begins in early adolescence. Adolescents who consume CABs, and particularly non-traditional CABs, are at increased risk of adverse outcomes.     

Alcohol policy support among mandated college students

Background

Alcohol consumption on college campuses is high, and often dangerous. College administrators have created policies to control alcohol consumption, but student body support or opposition of specific policies has been relatively unexplored.

Method

The current study examined the relations of alcohol policy support with gender and alcohol consumption. Mandated students (N = 229; 44% women) completed self-report assessments of alcohol policy support and alcohol consumption.

Results

Women supported policies to a greater extent than did men, as did lighter drinkers relative to heavier drinkers. Drinks per drinking day fully mediated the relation between gender and alcohol policy support.

Conclusion

While alcohol policy support differs by gender, this covariation is explained by differences in alcohol consumption. Findings have implications for addressing alcohol policy support among mandated college students.     

Evidence of deficits in behavioural inhibition and performance monitoring in young female heavy drinkers

Background

New models of the development and maintenance of substance abuse give increasing importance to the role of deficits in inhibitory function. Much of the evidence to support this claim comes from male participants, despite some researchers showing greater disinhibition in females. Clearly, more research on female heavy drinkers is warranted. In this study, we examine behavioural and psychophysiological measures of inhibitory function in female young adults who do and do not regularly drink heavily.

Methods

Participants were thirty female young adults (aged 18–21) who drink heavily (four or more standard drinks per occasion) at least once a month (n = 13) or who drink heavily less often than this (n = 17); none regularly used any other drugs, including tobacco. They underwent interviews assessing prior use of alcohol, before completing a stop-signal task while brain electrical activity was recorded.

Results

Regular heavy drinkers displayed a longer stop-signal reaction time (the time required to stop an inappropriate response), and a larger P3 increase for successful compared to failed inhibition trials. Heavy drinkers also displayed a smaller error-related negativity (ERN) amplitude, indexing a deficit in performance monitoring.

Conclusion

These results indicate that large deficits in inhibitory processing and performance monitoring occur in young female heavy drinkers, and that heavy drinkers may have to work harder in order to successfully inhibit a response. Future research may determine whether these deficits pre-date or are caused by alcohol abuse.     

The effect of rumination on craving across the continuum of drinking behaviour

Background

Rumination is an abstract, persistent, and repetitive thinking style that can be adopted to control negative affect. Recent studies have suggested the role of rumination as direct or indirect cognitive predictor of craving experience in alcohol-related problems.

Aims

The goal of this study was to explore the effect of rumination induction on craving across the continuum of drinking behaviour.

Methods

Participants of three groups of alcohol-dependent drinkers (N = 26), problem drinkers (N = 26) and social drinkers (N = 29) were randomly allocated to two thinking manipulation tasks: distraction versus rumination. Craving was measured before and after manipulation and after a resting phase.

Results

Findings showed that rumination had a significant effect on increasing craving in alcohol-dependent drinkers, relative to distraction, but not in problem and social drinkers. This effect was independent of baseline depression and rumination and was maintained across the resting phase. Conclusions: Rumination showed a direct causal impact on craving that is specific for a population of alcohol-dependent drinkers.     

Stereotypic information about drinkers and students' observed alcohol intake: An experimental study on prototype-behavior relations in males and females in a naturalistic drinking context

Background

Cross-sectional and longitudinal research has shown that favorable drinker prototypes (i.e., perceptions about the typical drinker) are related to higher levels of alcohol consumption in adolescents and college students. So far, few studies have experimentally tested the causality of this relationship and it is not clear what type of manipulation affects drinker prototypes and drinking levels.

Methods

In an experimental 1-factor design with two levels, we tested the short-term effects of exposing students to either positive or negative stereotypic information about drinkers on their drinker prototypes and actual drinking behaviors. We exposed 192 male and female college students to positive drinker prototype information (drinkers in general were presented as being attractive, sociable and successful), or to negative information (unattractive, unsociable and unsuccessful). Subsequently, participants’ levels of alcohol consumption were observed unobtrusively while they were interacting with peers in a naturalistic drinking context, namely a bar lab.

Results

Participants exposed to positive stereotypic information about drinkers reported more favorable drinker prototypes than participants exposed to negative stereotypic information. Multilevel analyses revealed that men's subsequent alcohol consumption in the bar lab was higher in the positive prototype condition than in the negative prototype condition. For women, no prototype effects on alcohol use were found.

Conclusions

These findings underline that drinker prototypes affect actual alcohol use in men and suggest that changing perceptions of drinkers may be a useful tool in alcohol prevention programs.     

Test–retest reliability of an online measure of past week alcohol consumption (the TOT-AL), and comparison with face-to-face interview

Objective

This paper reports on the development of a new online measure of beverage-specific past week alcohol consumption (the TOT-AL), its test–retest reliability, and comparability with the face-to-face approach of ascertaining alcohol intake.

Methods

University students participating in the reliability study completed the TOT-AL twice on the same day with at least 3 h apart. Students in the comparability study attended a face-to-face interview and completed the TOT-AL on the same day, in a randomised order, at least 3 h apart.

Results

There was a strong correlation between the repeated measurements of the TOT-AL (r = 0.99; 95% CI: 0.98, 0.99) and between the units calculated by the TOT-AL and the face-to face interview (r = 0.97; 95% CI: 0.95, 0.99). A high level of agreement between measurements was also observed in a Bland–Altman analysis.

Conclusions

The TOT-AL is a reliable, time efficient means of ascertaining alcohol intake, equivalent to that obtained face-to-face. These findings support the use of this approach to online alcohol assessment in populations with access to the Internet.     

Moderate/heavy alcohol use and HCV infection among injection drug users in two Russian cities

Background

In Russia, injection drug use and transmission of blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are inextricably linked, however the burden of alcohol use remains unexplored among injection drug users (IDUs).

Methods

Individuals who were 18 years of age and older and had injected drugs in the previous 30 days were recruited in the cities of Novosibirsk and Ivanovo by respondent driven sampling. Consenting individuals were administered a quantitative survey instrument and provided blood samples for serological testing.

Results

In Novosibirsk and Ivanovo, 29% and 35% of respondents were categorized as moderate/heavy drinkers, respectively. Individuals reported problems related to alcohol use that affected their physical health (23%), family (55%), and induced financial hardships (43%). In the multivariate analysis, we found that methamphetamine injection in the past 12 months was a strong and significant correlate of moderate/heavy drinking in Novosibirsk (aOR = 5.63 95% CI: [1.01–31.47]) and Ivanovo (aOR = 3.81 95% CI: [2.20–6.62]). There was poor agreement between self-reported HCV status and HCV test results (κ = −0.05 and 0.26 in Novosibirsk and Ivanovo, respectively). IDUs who correctly knew their HCV seropositive status in Novosibirsk and IDUs who correctly knew their HCV seronegative status in Ivanovo were significantly more likely to be moderate/heavy drinkers.

Conclusion

Alcohol use is problematic among IDUs who are at high risk for HCV. Future interventions should target IDUs who are moderate/heavy drinkers in order to prevent liver complications resulting from HCV infection.     

Alcohol use and negative consequences among active duty military personnel

Aims

An examination of alcohol use patterns in the active duty military to determine the relations of drinking levels and self-reported negative outcomes.

Design

A population-based cross-sectional study design using two-stage complex sampling methodology.

Setting

Paper and pencil surveys were administered anonymously in groups at 64 U.S. military installations worldwide.

Participants

Randomly selected active duty members (28,546) at major military installations representing the total active force, with the exception of recruits, cadets, and incarcerated personnel.

Measures

Personnel were classified into five drinking levels ranging from abstainer to heavy drinker based on quantity and frequency of alcohol intake. Negative outcomes were measured as self-reported serious consequences of alcohol use and alcohol-related productivity loss. Risk for other alcohol related problems was assessed by the Alcohol Use Disorders Identification Test (AUDIT).

Findings

Alcohol negative outcomes showed a curvilinear dose–response relationship with drinking levels. Higher levels of drinking were associated with higher rates of alcohol problems, but problem rates were notably higher for heavy drinkers. Heavy alcohol users showed nearly three times the rate of self-reported serious consequences and over twice the rate of self-reported productivity loss than moderate/heavy drinkers. Heavy drinkers also had the highest risk for alcohol problems on the AUDIT. One fifth of military personnel were heavy drinkers and were most likely aged 18 to 35.

Conclusions

Prevention and clinical interventions should include a major focus on heavy drinkers. Commanders and peers should be trained in recognizing signs of heavy alcohol use and in approaching heavy alcohol users in a way that will foster positive attitudes as opposed to defensiveness and stigma.     

Differential drinking patterns of family history positive and family history negative first semester college females

Objective

This study compares the natural drinking patterns of family history positive and family history negative women during their first semester of college, a transitional period known to coincide with considerable alcohol-related risks.

Method

Seventy-two incoming undergraduate females, approximately half of whom reported a family history of alcohol misuse, completed initial questionnaires as well as Timeline Followback assessments. In addition, participants completed five successive weeks of online behavioral diaries measuring three categories of prospective alcohol consumption: total drinks, maximum drinks, and heavy episodic drinking events. Repeated measures ANCOVA models, controlling for prior alcohol consumption, examined participants' drinking behavior.

Results

Over the course of the five assessed weeks, first semester females with a genetic predisposition to alcohol problems were found to consume significantly more total drinks (p < .05), maximum drinks (p < .05), and were more likely to drink heavily (p < .05) than family history negative peers.

Conclusions

Findings highlight increased alcohol-related risks faced by incoming first-year college females with a reported family history of problematic drinking and, thus, emphasize the need for early interventions targeted toward this at-risk group.     

Typology of alcohol users based on longitudinal patterns of drinking

Objective

Worldwide, alcohol is the most commonly used psychoactive substance. However, heterogeneity among alcohol users has been widely recognized. This paper presents a typology of alcohol users based on an implementation of idiographic methodology to examine longitudinal daily and cyclic (weekly) patterns of alcohol use at the individual level.

Method

A secondary data analysis was performed on the pre-intervention data from a large randomized control trial. A time series analysis was performed at the individual level, and a dynamic cluster analysis was employed to identify homogenous longitudinal patterns of drinking behavior at the group level. The analysis employed 180 daily observations of alcohol use in a sample of 177 alcohol users.

Results

The first order autocorrelations ranged from − .76 to .72, and seventh order autocorrelations ranged from − .27 to .79. Eight distinct profiles of alcohol users were identified, each characterized by a unique configuration of first and seventh autoregressive terms and longitudinal trajectories of alcohol use. External validity of the profiles confirmed the theoretical relevance of different patterns of alcohol use. Significant differences among the eight subtypes were found on gender, marital status, frequency of drug use, lifetime alcohol dependence, family history of alcohol use and the Short Index of Problems.

Conclusions

Our findings demonstrate that individuals can have very different temporal patterns of drinking behavior. The daily and cyclic patterns of alcohol use may be important for designing tailored interventions for problem drinkers.     

Brief motivational enhancement intervention to prevent or reduce postpartum alcohol use: A single-blinded,randomized controlled effectiveness trial

Aims

The aim of this study is to assess the effect of brief motivational enhancement intervention postpartum alcohol use.

Design

This study is a single-blinded, randomized controlled effectiveness trial in which pregnant women were assigned to receive usual care or up to 5 face-to-face brief motivational enhancement sessions lasting 10–30 minutes each and occurring at study enrollment, 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks postpartum.

Setting

The setting is in a large, urban, obstetrics clinic.

Participants

Participants were women who were ≥ 18 years old, < 20 weeks of gestation, and consumed alcohol during pregnancy. Of 3438 women screened, 330 eligible women were assigned to usual care (n = 165) or intervention (n = 165). Due to missing data, we analyzed 125 in the intervention group and 126 in the usual care group.

Measurements

The measurements were the proportion of women with any alcohol use and the number of drinks per day, reported via follow-up telephone interviews at 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks, 6 months, and 12 months postpartum.

Findings

In random effects models adjusted for confounders, the intervention group was less likely to use any alcohol (odds ratio 0.50; 95% confidence interval [CI], 0.23–1.09; P = 0.08) and consumed fewer drinks per day (coefficient − 0.11; 95% CI − 0.23–0.01; P = 0.07) than, the usual care group in the postpartum period but these differences were non-significant. Missing data during the prenatal period prevented us from modeling prenatal alcohol use.

Conclusions

Brief motivational enhancement intervention delivered in an obstetrical outpatient setting did not conclusively decrease alcohol use during the postpartum period.     

Very young adolescents and alcohol: evidence of a unique susceptibility to peer alcohol use

Aim

The aim of this study is to examine the susceptibility of very young adolescents (10–12 years of age) to peer alcohol-related influences, compared to older adolescents (13–14 years of age).

Methods

The analysis sample consisted of 7064 adolescents in grade 6 (modal age 11) or grade 8 (modal age 13) from 231 schools in 30 communities across three Australian States. Key measures were adolescent reports of alcohol use (past 30 days) and the number of peers who consume alcohol without their parent's awareness. Control variables included parent alcohol use, family relationship quality, pubertal advancement, school connectedness, sensation seeking, depression, length of time in high school, as well as age, gender, father/mother education, and language spoken at home. A multi-level model of alcohol use was used to account for school-level clustering on the dependent variable.

Results

For both groups, the number of peers who consumed alcohol was associated with alcohol use, but Grade 6 students showed a unique susceptibility to peripheral involvement with peer drinking networks (having one friend who consumed alcohol).

Conclusion

The results point to the importance of monitoring and responding to comparatively minor shifts in the proportion of peers who use alcohol, particularly among very young adolescents.     

Childhood abuse and neglect and transitions in stages of alcohol involvement among women: A latent transition analysis approach

Background

Childhood abuse and neglect have been linked with alcohol disorders in adulthood yet less is known about the potential of early trauma to influence transitions in stages of alcohol involvement among women. Study aims were to (1) identify stages of women's alcohol involvement, (2) examine the probability of transitions between stages, and (3) investigate the influence of four domains of childhood abuse and neglect (sexual abuse, physical abuse, neglect, and witness to domestic violence), assessed individually and as poly-victimization, on transitions.

Methods

The sample consisted of 11,750 adult female current drinkers identified in Wave 1 (2001–2002) and re-interviewed in Wave 2 (2004–2005) of the National Epidemiological Survey on Alcohol and Related Conditions.

Results

Three stages of alcohol involvement emerged from latent class analysis of 11 DSM-IV abuse/dependence criteria: severe (1.5% at Wave 1, 1.9% at Wave 2), hazardous (13.6% at Wave 1, 16.0% at Wave 2), and non-problem drinking (82.1% at Wave 1, 84.5% at Wave 2). Adjusted latent transition analyses determined transition probabilities between stages across waves. Women reporting any childhood abuse and neglect were more likely to advance from the non-problem drinking class at Wave 1 to severe (AOR = 3.90, 95% CI = 1.78–8.53) and hazardous (AOR = 1.56, 95% CI = 1.22–2.01) drinking classes at Wave 2 relative to women without this history. Associations were also observed between individual domains and transition from no problems to severe alcohol stage.

Conclusions

Results suggest a long-term impact of childhood abuse and neglect as drivers of progression in women's alcohol involvement.