WebMD Medical News
Laura J. Martin, MD
Nov. 16, 2010 -- Drinking energy drinks daily or even on a weekly basis may increase your risk of developing alcohol problems.
The new findings, which appear online in Alcoholism: Clinical & Experimental Research, are especially concerning given the trend of mixing alcohol with high-caffeine energy drinks.
In the new study of more than 1,000 college students, people who drank energy beverages 52 or more times a year were more than twice as likely as non-users to meet criteria for alcohol dependence. In addition, such "high-frequency users" were more likely to get drunk at an earlier age, drink more in one sitting, black out, and/or experience hangover symptoms that limited their usual activities, the study showed.
Overall, more than 60% of college students drank an energy beverage at some point in the past year and 10.1% had these drinks weekly and 2.6% daily or almost daily.
The study helps identify a new high-risk group, says Harold C. Urschel, MD, an addiction expert in Dallas. "People that drink these energy beverages daily or weekly need to be careful about alcohol consumption," he says. Urschel was not involved in the study.
Exactly how energy drinks increase risk for alcohol dependence is not fully understood. People who drink these beverages may rely on them to get through classes after a drinking binge or to power through a hangover. Alternatively, energy drinks may mask drunkenness and pave the road toward binge drinking, which raises the risk of future alcohol dependence.
When alcohol and energy drinks are drunk together, "the caffeine helps to disguise intoxication so you can drink more without realizing that you are drunk," Urschel tells WebMD. "You are more intoxicated and more revved up, and that is quite dangerous."
"This is serious," says study author Amelia M. Arria, PhD, the director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health in Baltimore and a senior scientist at the Treatment Research Institute in Philadelphia. "When you consume alcohol and energy drinks at the same time, it prolongs the drinking episode because it decreases your perceived level of intoxication, so you can drink for longer periods of time," she says.
This phenomenon is called "wide-awake drunkenness" and can lead to risky or even life-threatening behaviors, she says.
"I don't think it is ever safe to combine energy drinks with an alcoholic drink, and they are on the menu in many bars and restaurants," she says. Some energy drinks are pre-mixed with alcohol. Washington and Michigan have banned caffeinated alcoholic beverages.
"Drinking alcohol and caffeine at the same time is like hitting the gas and the brake at the same time," says John Higgins, MD, an assistant professor at the University of Texas Medical School at Houston and director of exercise physiology at Memorial Hermann Sports Medicine Institute, also in Houston.
"Alcohol is a known depressant, and these energy drinks have many materials in them that are known stimulants, the most common one being caffeine," he says.
The amount of caffeine or other ingredients in these energy drinks is not regulated. Some may have three of four times the amount of caffeine found in a cup of coffee, he says. Higgins recently published a paper on the caffeine content of energy drinks in the Mayo Clinic Proceedings.
"Manufacturers can put anything they want in here and some of the substances have stimulant effects themselves as well as caffeine-type effects, so you get a double hit," he says. "The FDA regulates things that are less dangerous than these beverages."
Susan Foster, vice president and director of Policy Research and Analysis at The National Center on Addiction and Substance Abuse (CASA) at Columbia University in New York City, agrees. "The combination of highly caffeinated, sugary drinks and alcohol is enormously dangerous in many ways."
For starters, "these are the equivalent of a binge drink in a can, and consuming high levels of caffeine, which increase alertness and take away the usual signals that getting drunk, can lead to alcohol poisoning," she says.
It takes two to tango, says Toben F. Nelson, ScD, a professor of epidemiology & community health at the University of Minnesota School of Public Health in Minneapolis. "The stimulant can mask the depressant effect and students don't realize how intoxicated they are so they consume more," he says. "The combined effects of alcohol and caffeine really are making students more susceptible to the risks of alcohol and heavy drinking, and this is a relatively new phenomenon."
The new study does not show that drinking energy drinks encourages alcohol dependence, Maureen Storey, PhD, senior vice president for science policy for the American Beverage Association, the trade association representing companies making non-alcoholic drinks, says in a statement.
What's more,"there is nothing unique about the caffeine in energy drinks. In fact, most mainstream energy drinks actually contain about half the caffeine of a similar size cup of coffee house coffee," she says. "The authors’ focus on this product category does little to shed light on the serious problem of binge drinking and alcoholism among young adults."
SOURCES:Arria, A. Alcoholism: Clinical and Experimental Research, published online Nov. 12, 2010.Amelia M. Arria, PhD, director, Center on Young Adult Health and Development, University of Maryland School of Public Health; senior scientist, Treatment Research Institute, Philadelphia.Susan Foster, vice president, director, policy research and analysis, The National Center on Addiction and Substance Abuse , Columbia University, New York.John P. Higgins, MD, assistant professor, University of Texas Medical School, Houston.Maureen Storey, PhD, senior vice president, science policy, American Beverage Association, Washington.Harold C. Urschel, MD, addiction expert, Dallas.Higgins, J. Mayo Clinic Proceedings, 2010; vol 85: pp 1033-1041.Toben F. Nelson, ScD, professor, epidemiology & community health, University of Minnesota School of Public Health, Minneapolis.
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