High-risk cocktails and high-risk sex: Examining the relation between alcohol mixed with energy drink consumption,sexual behavior,and drug use in college students

Alcohol mixed with energy drink (AmED) consumption has garnered considerable attention in the literature in recent years. Drinking AmED beverages has been associated with a host of negative outcomes. The present study sought to examine associations between AmED consumption and high-risk sexual behaviors in a sample of young adults. Participants (N = 704; 59.9% female) completed an online survey assessing AmED consumption, other drug use, and sexual behavior. A total of 19.4% of the entire sample (and 28.8% of those who reported using alcohol) reported consuming AmED. Participants who reported consuming AmED were significantly more likely to report marijuana, cocaine, and ecstasy use. Those who reported consuming AmED also had increased odds of engaging in high-risk sexual behaviors, including unprotected sex, sex while under the influence of drugs, and sex after having too much to drink. Relationships between AmED consumption and sexual behavior remained significant after accounting for the influence of demographic factors and other substance use. Results add to the literature documenting negative consequences for AmED consumers, which may include alcohol dependence, binge drinking, and the potential for sexually transmitted infections via high-risk sexual behavior.     

Energy Drink and Alcohol mixed Energy Drink use among high school adolescents: Association with risk taking behavior,social characteristics

PurposeThe aims of the study were to: a) examine the prevalence of energy drink (ED) and alcohol mixed with energy drink (AmED) consumption; b) investigate the relationships between ED and AmED with alcohol, binge drinking and drugs accounting for at risk behaviors among a representative sample of Italian adolescents.MethodsA representative sample of 30,588 Italian high school students, aged 15–19 years, was studied. Binary and multivariate logistic regression analyses were performed to determine the independent association of the potential predictors' characteristics with the ED and AmED drinking during the last year.ResultsRespectively 41.4% and 23.2% of respondents reported drinking EDs and AmEDs in the last year. Multivariate analysis revealed that consumption of EDs and AmEDs during the last year were significantly associated with daily smoking, binge drinking, use of cannabis and other psychotropic drugs. Among life habits and risky behaviors the following were positively associated: going out with friends for fun, participating in sports, experiencing physical fights/accidents or injury, engaging in sexual intercourse without protection and being involved in accidents while driving.ConclusionsThis study demonstrates the popularity of ED and AmED consumption among the Italian school population aged 15–19 years old: 4 out of 10 students consumed EDs in the last year and 2 out of 10 AmED. Multivariate analysis highlighted the association with illicit drug consumption and harming behaviors, confirming that consumption of EDs and AmEDs is a compelling issue especially during adolescence, as it can effect health as well as risk taking behaviors.     

Combined use of alcohol and energy drinks: Dose relationship with self-reported physiological stimulation and sedation side effects

BackgroundNegative physiological stimulation and sedation side effects are experienced by a significant proportion of consumers who consume alcohol mixed with energy drinks (AmED). Few studies have compared the frequency of side effects between sessions of AmED and sessions of alcohol only within-subject, and none have explored a dose relationship.ObjectivesExplore the occurrence of self-reported physiological stimulant and sedative side effects between sessions of AmED and alcohol only, and at varying ED dosage levels within AmED sessions.MethodsA convenience sample of 2953 residents of New South Wales, Australia completed an online survey. N = 731 AmED users reported daily caffeine intake, typical alcohol and AmED consumption, and past 12-month experience of physiological stimulation and sedation side effects during AmED and alcohol only sessions. Within-subject analyses compared occurrence of side effects between session types. Hierarchical binary logistic regression analyses explored the association of ED dose during AmED sessions with the experience of physiological side effects.ResultsThere were greater odds of most stimulant side effects, and lower odds of sedation side effects, during AmED sessions compared to alcohol only sessions. Compared to one ED, consumption of three or more EDs was significantly associated with the majority of both stimulant and alcohol intoxication side effects after controlling for demographics and consumption covariates.ConclusionsAmED is associated with perceived changes in physiological stimulant and sedation side effects of alcohol. Experience of side effects is positively associated with ED dosage. Future research should account for varying ED dosage, and reflect real world consumption levels.     

Drinking patterns and risk behaviors associated with combined alcohol and energy drink consumption in college drinkers

Objective

In recent years the consumption of alcohol mixed with energy drinks (AmED) has become popular in young adults in North America. There have been few studies into the drinking patterns and risk behaviors that accompany this new form of alcoholic beverage consumption and more information is required to support harm reduction and prevention efforts. This paper goes beyond previous research by investigating risk behaviors associated with AmED use while (1) controlling for risk-taking propensity, (2) examining a range of outcomes (e.g. stimulant drug use), and (3) replicating previous findings in a Canadian sample.

Method

In winter 2009/10, a web-based survey was completed by 465 students (56% female) attending a university in Western Canada. Regression analyses were used to investigate whether consumption of AmED is associated with heavy drinking, stimulant drug use, and alcohol-related consequences.

Results

A total of 105 students (23%) reported consuming AmED in the past 30 days. These students were more likely to be heavier drinkers, than non-AmED users after controlling for risk-taking propensity. More frequent AmED drinkers had twice the odds of experiencing one or more negative consequences from AmED use (e.g. drinking and driving, being hurt or injured), compared to less frequent drinkers after controlling for risk-taking propensity and drinking behavior.

Conclusions

Students who consume AmED are at increased risk for harms. Therefore, consuming AmED should be considered “high-risk drinking” for university students and efforts should be made to discourage combined consumption.     

The effect of price increases on predicted alcohol purchasing decisions and choice to substitute

Introduction: Few studies have undertaken to explore whether people who consume particular alcoholic beverages have a greater tendency to substitute with cheaper alcohol in response to price increases. The aim of this study was to investigate the effect of price increases on alcohol purchasing decisions, specifically the influence on brand and cross-beverage substitution across demographic, drinking level and socio-economic factors.

Method: Data on participants’ alcohol purchasing habits and consumption were collected via an online survey, including their reactions to three price increases to alcoholic beverages types previously purchased. Data were analysed using logistic regression, with substitution behaviour the dependent variable, controlling for demographic and socio-economic factors.

Results: Responses to different price increases varied by drinking level, which was consistently and significantly associated with likelihood of substitution behaviour across beverage types. For a 50% increase in price, regardless of whether participants purchased beer, wine, bottled spirits or premixed spirits, drinking at levels which put participants at high risk of short-term harms was associated with a higher likelihood of substitution with cheaper brands or beverage types (OR: 1.729; OR: 1.787; OR: 1.729 and OR: 1.729, respectively).

Conclusions: No consistent trends in responses occurred according to respondent characteristics, suggesting that increasing price may be an effective tool to influence purchasing behaviour across the population. Results also suggested that those who drink at levels which put them at high risk of short-term harms may be more likely to circumvent price increases by switching to a cheaper product.     

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.     

Why are caffeinated alcoholic beverages especially risky?

PurposeEvidence suggests that people drink more alcohol and experience more adverse alcohol-related consequences (ARCs) on occasions when they also consume caffeine. The current study examined whether this increase in risk is a result of caffeine attenuating the subjective effects of alcohol intoxication (i.e., the masking hypothesis).MethodsUndergraduate students (n = 148) reported their drinking patterns using a modified Timeline Followback approach. For each recalled drinking occasion, alcohol consumption, caffeine consumption, perceived blood alcohol concentration, and ARCs were assessed. Generalized linear mixed models were used to examine the influence that alcohol and caffeine consumption had on perceived intoxication and the experience of ARCs.ResultsAt the occasion level, greater caffeine consumption was associated with increased consumption of alcohol and increased ARCs. There was also a significant curvilinear relationship between the amount of alcohol consumed and perceived intoxication, such that the more alcohol was consumed on each occasion the less each additional drink increased perceived intoxication. Increased caffeine consumption weakened the association between alcohol consumption and perceived intoxication and it also weakened the association between alcohol consumption and ARCs. Specifically, the weakest relationship between ARCs and alcohol consumption existed at the highest level of caffeine consumption (240+ mg). Caffeine increased subjective intoxication.ConclusionsThese findings do not support the masking hypothesis. Caffeine was strongly associated with ARCs when consumed at high doses and this effect does not appear to be the result of drinking more alcohol or underestimating one's blood alcohol content. Efforts to reduce caffeinated alcohol beverage use are greatly needed.     

Effects of energy drinks mixed with alcohol on information processing, motor coordination and subjective reports of intoxication

The consumption of alcohol mixed with energy drinks (AmED) has become a popular and controversial practice among young people. Increased rates of impaired driving and injuries have been associated with AmED consumption. The purpose of this study was to examine if the consumption of AmED alters cognitive processing and subjective measures of intoxication compared with the consumption of alcohol alone. Eighteen participants (nine men and nine women) attended four test sessions where they received one of four doses in random order (0.65 g/kg alcohol, 3.57 ml/kg energy drink, AmED, or a placebo beverage). Performance on a psychological refractory period (PRP) task was used to measure dual-task information processing and performance on the Purdue pegboard task was used to measure simple and complex motor coordination following dose administration. In addition, various subjective measures of stimulation, sedation, impairment, and level of intoxication were recorded. The results indicated that alcohol slowed dual-task information processing and impaired simple and complex motor coordination. The coadministration of the energy drink with alcohol did not alter the alcohol-induced impairment on these objective measures. For subjective effects, alcohol increased various ratings indicative of feelings of intoxication. More importantly, coadministration of the energy drink with alcohol reduced perceptions of mental fatigue and enhanced feelings of stimulation compared to alcohol alone. In conclusion, AmED may contribute to a high-risk scenario for a drinker. The mix of behavioral impairment with reduced fatigue and enhanced stimulation may lead AmED consumers to erroneously perceive themselves as better able to function than is actually the case.     

Drinking patterns and harm of unrecorded alcohol in Russia: a qualitative interview study

Background: Consumption of unrecorded alcohol (alcohol, consumed as a beverage, but not reflected in official statistics) has been linked to heavy drinking and alcohol-related mortality in Russia, with different studies looking for possible toxic components or other explanations. This study explores self-reported drinking behaviors of people diagnosed with alcohol dependence to elicit the perspectives of consumers of unrecorded alcohol.

Methods: Semi-structured in-depth expert interviews were conducted with patients (n?=?25) of state-run addiction treatment centers of two Russian cities. Interviews were analyzed using thematic content analysis.

Results: A strict hierarchy between different types of unrecorded alcohol products, their ascribed quality, and the subjective harm caused by their consumption was found, with home-made spirits for own consumption at the top and technical fluids at the bottom. The ranking order correlated with product price, social status of associated consumers, and severity of their alcohol dependence. Binge drinking was the prevailing drinking pattern and shifts from recorded to unrecorded consumption within a single binge or a zapoi (continuous drinking for at least two days) were typical. Consumption of low-quality unrecorded alcohol was associated with stronger hang-overs, zapois, alcohol psychoses and poisonings, and other indicators of alcohol attributable harm, while no such connection was found for spirits for own consumption.

Conclusions: In the dominant explanation patterns of the consumers, the experienced alcohol-induced harm is attributed to alcohol quality, while a thorough analysis of their reported drinking behaviors cannot exclude specific drinking patterns linked to the severity of alcohol dependence as the main determinants of the described health detriments.     

The multiplicative effect of combining alcohol with energy drinks on adolescent gambling

PurposeThere has been increased concern about the negative effects of adolescents consuming a combination of alcohol mixed with energy drinks (AmED). To date, few studies have focused on AmED use and gambling. The present study analyzed the multiplicative effect of AmED consumption, compared to alcohol alone, on the likelihood of at-risk or problem gambling during adolescence.MethodsData from the ESPAD®Italia 2015 study, a cross-sectional survey conducted in a nationally representative sample of students (ages 15 to 19 years) were used to examine the association between self-reported AmED use (≥ 6 times, ≥ 10 times, and ≥ 20 times during the last month) and self-reported gambling severity. Multivariate models were used to calculate adjusted prevalence ratios to evaluate the association between alcohol use, AmED use, and gambling among a representative sample of adolescents who reported gambling in the last year and completed a gambling severity scale (n = 4495).ResultsAmong the 19% students classed as at-risk and problem gamblers, 43.9% were classed as AmED consumers, while 23.6% were classed as alcohol consumers (i.e. did not mix alcohol with energy drinks). In multivariate analyses that controlled for covariates, AmED consumers were three times more likely to be at-risk and problem gamblers (OR = 3.05) compared to non-consuming adolescents, while the effect became less pronounced with considering those who consumed alcohol without the addition of energy drinks (OR = 1.37).ConclusionsThe present study clearly established that consuming AmED might pose a significantly greater risk of experiencing gambling-related problems among adolescents.     

Mixing alcohol with energy drink (AMED) and total alcohol consumption: a systematic review and meta‐analysis

It has been suggested that consuming alcohol mixed with energy drink (AMED) may increase total alcohol consumption. Aims of this systematic review and meta‐analysis were (i) to compare alcohol consumption of AMED consumers with alcohol only (AO) consumers (between‐group comparisons), and (ii) to examine if alcohol consumption of AMED consumers differs on AMED and AO occasions (within‐subject comparisons). A literature search identified fourteen studies. Meta‐analyses of between‐group comparisons of N = 5212 AMED consumers and N = 12 568 AO consumers revealed that on a typical single drinking episode AMED consumers drink significantly more alcohol than AO consumers (p = 0.0001, ES = 0.536, 95%CI: 0.349 to 0.724). Meta‐analyses of within‐subject comparisons among N = 2871 AMED consumers revealed no significant difference in overall alcohol consumption on a typical drinking episode between AMED and AO occasions (p = 0.465, ES = ?0.052, 95%CI: ?0.192 to 0.088). In conclusion, between‐group comparisons suggest that heavy alcohol consumption is one of the several phenotypical differences between AMED and AO consumers. Within‐subject comparisons revealed, however, that AMED consumption does not increase the total amount of alcohol consumed on a single drinking episode. © 2016 The Authors. Human Psychopharmacology: Clinical and Experimental Published by John Wiley & Sons Ltd     

Do Alcohol Consumption Patterns of Adolescents Differ by Beverage Type?

ABSTRACT

The overall purpose of this study was to explore the alcohol consumption patterns of adolescents by beverage type. A total of 705 primarily 9th grade students were recruited to participate in this study in the spring of 2002. Alcoholic beverage use differed significantly across gender and ethnicity on a number of beverage-specific drinking measures, including initiation, quantity and frequency, binge drinking, chugging, and alcohol problems (p's<.05). Stepwise discriminant analyses indicated that drug use and social beliefs were notably important in discriminating adolescent drinkers from non-drinkers of specific alcoholic beverages. This study's results indicate the need for testing interventions tailored to alcohol consumption patterns including beverage type.     

Ethanol beverage anticipation: effects on plasma testosterone and luteinizing hormone levels--a pilot study

Levels of plasma testosterone (T) and luteinizing hormone (LH) were evaluated in alcoholic and control subjects while they smelled a real beer and then drank a placebo beer which they believed contained alcohol. Plasma T and LH differed in the alcoholics and controls during beverage presentation and T levels also differed during drink consumption. Although these results suggest a role for conditioned responses, the lack of concordance between the hormone levels and psychophysiological responses or self-report desire to drink does not support a conditioning hypothesis that could account clearly for consumption behavior. Alternative hypotheses are discussed.     

A Comparison of Alcohol Consumption Intentions Among Pregnant Drinkers and Their Nonpregnant Peers of Child-Bearing Age

Objective: To investigate alcohol consumption intentions among Australian women of childbearing age by pregnancy status. Methods: Three national online surveys were conducted with adult drinkers who consume an alcoholic beverage at least two days per month. Data from female respondents of childbearing age were analyzed according to pregnancy status: pregnant (n = 101), possibly pregnant (n = 178), and not pregnant (n = 1,957). Results: Pregnant drinkers were significantly more likely than possibly pregnant and nonpregnant drinkers of child-bearing age to report that they should and will reduce their alcohol consumption. Results showed that 33% of the pregnant women, 32% of the nonpregnant women, and 39% of the possibly pregnant women reported intending to drink five or more standard drinks on a single occasion in the following two weeks. Older pregnant women exhibited higher rates of heavy drinking intentions and lower intentions to reduce their consumption relative to younger pregnant women. Conclusion: Despite current alcohol consumption guidelines recommending abstinence while pregnant, pregnant respondents exhibited heavy episodic drinking intentions comparable to those of their nonpregnant peers. Implications: There is a need to increase public awareness of current alcohol guidelines for pregnant women. Older women of childbearing age and those planning a pregnancy may require particular attention.     

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

BackgroundEnvironmental 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.MethodsStructured observations were undertaken in five Australian cities on Friday and Saturday nights. Covert teams spent 4–5 h in venues and recorded hourly observations on patron, venue, and staff characteristics, alcohol, illicit drug and AmED consumption patterns and intoxication levels.Results898 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.ConclusionAmED 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.     

Experimental analysis of the ‘happy hour’: Effects of purchase price on alcohol consumption

An experimental analogue of a discount drink policy known as the happy hour was used to study the effects of purchase price on drinking behavior. Male volunteers with a prior history of either casual (N=20) or heavy (N=14) drinking were given free access to beverage alcohol during a 20-day period. Approximately half the subjects could purchase alcohol under a single-price condition (50 ¢/drink), while a matched group was given a price reduction daily (25 ¢/drink) during a three-hour period in the afternoon. The results demonstrated that the afternoon price reduction significantly increased alcohol consumption in both casual and heavy drinkers. Reinstatement of the standard purchase price effectively suppressed drinking in both groups. The findings are discussed in terms of the theoretical and research implications of environmental influences on drinking.     

Divergent drinking patterns and factors affecting homemade alcohol consumption (the case of Russia)

BackgroundUnrecorded homemade alcohol consumption has been less examined in the literature. Previous studies of homemade alcohol in Russia have almost entirely focused upon the use of samogon (moonshine) attributed to the northern style of drinking. No systematic analysis is available regarding the production and consumption of homemade wine. This paper explores the drinking patterns demonstrated by consumers of samogon and homemade wine in Russia. The main factors affecting the consumption of these beverages are investigated.MethodsData were collected from a 2014 nationwide survey of 14,986 respondents aged 15+ years. Beverage preferences, volume of consumed alcohol, drinking habits, and alcohol availability were the main measures reported. Demographic, socio-economic, spatial, and policy-related factors affecting homemade alcohol consumption are examined using logistic regression.ResultsThe percentages of samogon and homemade wine consumers were similar, although a greater volume of samogon in pure alcohol was consumed compared to homemade wine. The groups of samogon and homemade wine consumers showed very little overlap. Unlike homemade wine consumers, samogon drinkers consumed larger amounts of alcohol and were more engaged in frequent and excessive drinking, drinking without meals and drinking in marginal public settings. Gender, education, regional affiliation, and type of residence showed opposite associations with regard to the consumption of samogon and homemade wine. Availability of homemade alcohol in the neighbourhood was the most influential predictor due to respondents’ own production, presence of homemade alcohol in friendship networks and at illegal market. The prices of manufactured alcohol and the consumption of homemade alcohol did not show significant relationships.ConclusionConsumers of samogon and homemade wine demonstrate contrasting drinking patterns that are largely driven by different factors. Samogon is consumed in a more hazardous manner, whereas homemade wine is consumed in a more moderate and law-abiding way. Illegal commercial samogon should be a special concern for alcohol policy.     

The measurement of drinking patterns and alcohol problems in Nigeria

As in most other societies, alcoholic beverages have been consumed in what is present-day Nigeria for a long time. Before the arrival of western factory-made drinks, alcohol consumption was limited to a variety of beverages produced from palm trees and food grains. Today, beer has become the most popular drink in the country but traditional beverages (palm wine, burukutu, ogogoro, pito) are still widely consumed in both rural and urban areas. Though research has shown that heavy drinking seems to be the norm among those who drink any type of alcohol, there is no clear association between drinking and social or health problems. On the other hand, certain types of beverages are linked with positive attributes. Despite their potential significance, these and other issues have not received the attention they deserve in the alcohol research literature on Nigeria and other African countries. The focus of this paper is on the need to take into consideration relevant measurement issues (e.g., container and serving size, alcohol contents, drinking expectancies, perceived risks associated with the consumption of different types of alcoholic beverages, as well as reasons for drinking) in alcohol research. It is suggested that a better understanding of these and related factors is necessary for the advancement of alcohol epidemiology in the country.     

Drinking and driving: explaining beverage-specific risks

OBJECTIVE: This study tested whether the association of beer drinking with drinking and driving is due to cultural norms or is an artifact arising from the demographic profile of beer drinkers (young and male), the drinking patterns of this subpopulation (frequent and heavy), and the venues in which they prefer to drink (bars and restaurants). METHOD: Telephone survey data from six U.S. communities were used to establish the demographic characteristics of drinkers, their consumption patterns, beverage preferences, preferred drinking venues and self-reported drinking and driving rates. The survey completion rate was 64.6%. A total sample of 5,231 drinkers was divided into test and validity samples. After deletion of cases with missing data, the test sample included 2,275 drinkers, of whom 985 had driven after drinking. RESULTS: Controlling for a broad set of covariates, the analyses showed that frequent consumers were more likely to drink outside the home, preferred beer and spirits to wine, and were more likely than others to drink and drive. Beverage preferences were not directly associated with drinking and driving. Beer drinkers, however, were from the subpopulation most likely to drink and drive: heavier drinking younger men, who prefer to drink at bars and restaurants. CONCLUSIONS: These results suggest that the association of beer consumption with drinking-driving arises from the circumstances in which the subpopulation of beer drinkers more commonly find themselves (as a result of their efforts to maximize, within economic constraints, the social and amenity value of drinking), as opposed to any culturally induced disposition beer drinkers may have to drink and drive.