Energy Drinks and Alcohol

Caffeinated cocktails are a popular trend among young adults in the United States, but the combination is ill-advised. Research indicates that combining energy drinks and alcohol can lead to risky behavior and dangerous drinking practices. Alcoholic energy drinks may even change brain neurochemistry in adolescents in much the same way cocaine does.
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Mixing alcohol with energy drinks is a common practice in the United States, especially among young people. In 2015, more than one-third of young adults between the ages of 19 and 28 said they’d consumed alcohol with energy drinks, and 13 percent of eighth-, 10th- and 12th-graders have drunk alcohol and energy drinks together.

But a growing body of evidence shows that spiking your Red Bull with vodka can be dangerous and even deadly.

“It seems the two substances together push them over a limit that causes changes in their behavior and changes the neurochemistry in their brains.”
Richard van Rijn, assistant professor of medicinal chemistry and molecular pharmacology, Purdue University

While people seem to enjoy the party-all-night stamina they get from combining a caffeinated energy drink with alcohol, experts say the mixture creates a different and dangerous type of intoxication in people sometimes referred to as “wide awake drunk.”

“The stimulant effects of caffeine mask the result that most people get when they drink,” said Audra Roemer, a Canadian researcher who has studied the risks associated with caffeine cocktails.

“Usually when you’re drinking alcohol, you get tired and you go home,” Roemer said, but large amounts of caffeine can disguise those sedating effects. As a result, “people may underestimate how intoxicated they are, end up staying out later, consume more alcohol and engage in risky behavior and more hazardous drinking practices.”

A Hazardous Mix for Adolescents and Young Adults

While the risks of mixing drugs and alcohol may seem obvious, many people forget that caffeine is a stimulant drug. Energy drinks often contain other supplements, such as guarana, ginseng and taurine, which may also impact the central nervous system.

Drinkers between the ages of 15 and 23 who combine alcohol and energy drinks are four times more likely to binge drink at a high intensity than those who don’t mix alcohol and energy drinks, according to the Centers for Disease Control and Prevention.

College students who consume energy drinks on a regular basis have a greater risk of developing an alcohol addiction and other types of substance use disorders, according to research by the National Institute on Drug Abuse.

Mixing energy drinks and alcohol is also linked to risky sexual behavior, drunk driving and riding as the passenger of an intoxicated driver, studies show. Researchers at the University of Florida found that college-aged people who consume energy drink cocktails are four times more likely to drive drunk than those who don’t.

Some research even suggests that mixing energy drinks and alcohol can trigger changes in the adolescent brain that mimic the effects of taking cocaine.

In 2015, more than one-third of young adults consumed alcohol with energy drinks.

“It seems the two substances together push them over a limit that causes changes in their behavior and changes the neurochemistry in their brains,” Richard van Rijn, an assistant professor of medicinal chemistry and molecular pharmacology who spearheaded the research at Purdue University, said in a press release. “We’re clearly seeing effects of the combined drinks that we would not see if drinking one or the other.”

The study, which used adolescent mice as its test subjects, found elevated levels of a protein called ΔFosB (DeltaFosB) in the brains of the mice that were fed caffeinated alcohol. The protein has been described as a molecular switch for addiction because it’s typically elevated in those who are abusing drugs such as cocaine or morphine.

Interestingly, when the mice exposed to alcohol and caffeine became adults, they were less sensitive to the euphoric effects of cocaine. While that might seem on the surface as a positive thing, the researchers said it is actually concerning because a mouse using cocaine would seek more of it to get the same level of pleasure as a mouse who hadn’t indulged in caffeinated alcohol.

“Their brains have been changed in such a way that they are more likely to abuse natural or pleasurable substances as adults,” said van Rijn.

Caffeinated cocktail drinkers are more likely to land in the hospital, too. In 2011, nearly half of all energy-drink related visits to hospital emergency departments involved situations in which the caffeinated beverages were combined with alcohol or other drugs.

Drinkers between the ages of 15 and 23 who combine alcohol & energy drinks are 4x more likely to binge drink.

Sixteen students at Ramapo College in New Jersey were hospitalized for severe alcohol intoxication after consuming a heavily caffeinated malt liquor beverage called Four Loko in the fall of 2010. Not long after, nine college students in Washington State also became ill and landed in the hospital after drinking the fruit-flavored beverage, which is equivalent to four beers and two Red Bulls and is nicknamed “blackout in a can.”

The drink was also linked to several deaths, including a 20-year-old Florida man who shot himself after binging on the beverage and a 21-year-old Maryland woman who crashed her truck into a telephone pole after consuming Four Loko.

Following a widespread outcry about the dangers of the product and a crackdown by the Food and Drug Administration, Four Loko and beverages like it were pulled from the market and reformulated to remove caffeine and other stimulants.

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An Ongoing Problem

While the 2010 FDA crackdown banned the sale of premixed alcoholic energy drink products, the move hasn’t put an end to the caffeine-laced cocktail craze.

People can still mix their own at home, and bars serve up these mixtures, such as in drinks called Jäegerbombs, which are shots of Jäegermeister dropped into half a can of Red Bull, and the ever-popular vodka-Red Bull combo.

Restaurants also serve energy drink cocktails. Twin Peaks restaurant, for example, serves a drink called Tropic Thunder, a combination of Red Bull Tropical Yellow, Malibu coconut rum and Bacardi Rum. And Boston’s Pizza has four Red Bull cocktails on its menu, including the Green Monster, a citrusy drink made from vodka, rum, gin, schnapps, curacao and Red Bull.

Although some states are doing what they can to discourage the practice — Washington state, for example, bans liquor stores from disseminating any marketing materials encouraging customers to mix energy drinks with alcohol — the trend is still widespread.

While avoiding alcoholic energy drinks is the safest way to go, if you decide to drink caffeinated cocktails anyway, the British charity Drinkaware Trust has several recommendations. First, keep close track of how much you are drinking so you don’t overindulge, and keep a close eye on friends and drinking buddies so that they don’t get into trouble.

Also, make sure to eat so you don’t get drunk as quickly. Keep tabs on how much sugar and caffeine you’re actually consuming because both can cause other ill health effects. And be sure not to drink alcoholic energy drinks close to bedtime if you want to sleep because these beverages cause insomnia.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Amy Keller, RN, BSN
Content Writer,
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
Medical Reviewer
Ashraf Ali
Psychiatrist, Los Angeles County Department of Mental Health

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