Despite FDA Warning, State Bans, Dangerous Practice of Mixing Energy Drinks With Alcohol Continues

Megan Brooks

December 09, 2010

December 9, 2010 — State bans on caffeinated alcoholic beverages and a warning by the US Food and Drug Administration (FDA) to 4 companies to stop selling their products are unlikely to keep young people away from this dangerous combination, according to Jonathan Howland, PhD, of the Department of Community Health and Emergency Medicine, Boston University, in Massachusetts.

"We have some survey data from a college population that indicates that the vast majority of students that are drinking caffeinated alcoholic beverages are mixing them themselves — not buying the premixed products," he told Medscape Medical News.

"Getting these products off the market is not necessarily going to stop people from mixing them themselves," he warned. "There is no sign that young people have decreased the practice of combining alcohol and energy drinks."

In an article published online November 30 in the American Journal of Preventive Medicine, Dr. Howland and colleagues highlight the scope of the problem of caffeinated alcoholic beverages and suggest areas of research that might help address it.

The root of the problem of caffeinated alcoholic beverages may have started with the energy drink craze. "The energy drink market is a multibillion-dollar industry that targets teens and young adults," Dr. Howland and colleagues write.

As a result of "aggressive and innovative" marketing tactics targeting young people, it is currently estimated that 31% of young teens and up to 51% of young adults 18 to 21 years old regularly consume energy drinks.

One survey of teens found 76% use energy drinks to boost energy and alertness. Another survey of college students showed that 67% use energy drinks because of a lack of sleep, 65% use then to boost energy. and 54% to drink with alcohol while partying. Seventeen percent of those surveyed said they use energy drinks to combat hangovers, despite any evidence that the practice works.

Riskier Behavior?

Depending on the brand, energy beverages contain several stimulants, primarily caffeine, but also guarana, taurine, and sugar derivatives. Of the 577 caffeinated beverages listed on the Energy Fiend Website in 2008, at least 130 contained more than the 0.02% caffeine limit for soft drinks imposed by the FDA, the investigators note.

Combining energy drinks with alcohol became popular when marketers fueled the idea that energy drinks counteract the sedating effects of alcohol and related impairment, allowing individuals to keep drinking longer.

"While evidence continues to mount that drinking caffeinated alcoholic beverages is risky business, at present, the exact health consequences are "not well understood,” Dr. Howland says.

In the article the investigators cite 1 study that found that bar patrons who consumed caffeinated alcoholic beverages were 3 times more likely to leave the bar highly intoxicated compared with those who consumed alcohol without caffeine. They were also 4 times more likely to say they intended to get behind the wheel after leaving the bar.

Another study found that students who consumed caffeinated alcoholic beverages had approximately double the risk of experiencing or committing sexual assault, riding with an intoxicated driver, having an alcohol-related accident, or requiring medical treatment.

But beyond descriptive studies that reveal associations between caffeinated alcoholic beverages and alcohol-related harm, "little is known about the mechanisms that underlie these risks," said Dr. Howland.

"Yes, there are some survey data that suggest that people who drink caffeinated alcoholic beverages, relative to people who just drink straight alcohol, engage in riskier behavior," Dr. Howland told Medscape Medical News.

"The question that is unclear is whether it is something about caffeinated alcoholic beverages that leads to risky behavior or whether people who are prone to engage in risky behavior are also prone to drink caffeinated alcoholic beverages."

Urgent Need for Research

"The causal order here is unclear," Dr. Howland emphasized. He said he is not aware of any studies that been conducted to look at this. "There are many hypotheses that are perfectly reasonable, but they haven't been tested."

"Does drinking a caffeinated alcoholic beverage mean that you drink more because the caffeine offsets the sensation of drowsiness or your usual physiologic consequences of the alcohol?

"It's reasonable to think that the caffeine is keeping you more alert and distorting your sense of how intoxicated you are so you drink more, but we really don't know and we should do the research to find out,” said Dr. Howland.

He added his research group is seeking funding to conduct studies to answer many of these questions.

By calling for more research, Dr. Howland emphasized that he is not trying to second-guess state and federal health authorities on caffeinated alcoholic beverages.

"I am a researcher, so my job is to be skeptical and raise questions. The people who have taken action against these beverages have a different mandate, to protect the public; they are doing their job. In raising these questions and calling for research, I'm just saying we all, as a society, would know more if we did the research," he said.

The study authors have disclosed no relevant financial relationships.

Am J Prev Med. Published online November 30, 2010.

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