Daily Context of Alcohol Mixed with Energy Drinks: Targets for Intervention

Introduction: Alcohol mixed with energy drinks (AmEDs; e.g., Red Bull and vodka) are popular on college campuses. Their use is associated with heavy drinking and harms more than other types of alcohol, potentially due to AmEDs masking the sedative effects of alcohol. Although the link between AmED use and harms is established, scant research has examined the context in which AmEDs are consumed. Identifying the characteristics of use may reveal if AmEDs are consumed in settings that increase the odds of engaging in risky behaviors. Further, the way in which individuals consume AmEDs may reflect their motives for consuming it or beliefs about its effects. This information could aid in campus prevention policy development and identification of intervention targets for problematic AmED use.

Methods: This study used a two-week daily diary design to compare days in which AmEDs were used (“AmED days”) and days where other types of alcohol were used (“non-AmED days”) on where, when, and with whom drinking occurred. Participants were 122 (90 women) heavy drinking college students who reported mixing caffeine with alcohol at least once in the past week. The majority were Caucasian (54.9%) and seniors (32.8%). Mean age was 20.39 (SD = 2.08) years old. Data were collected across 389 drinking days; 40 of these days involved AmEDs.

Results: Multilevel modeling revealed that odds of drinking at a bar or club were higher on AmED days relative to non-AmED days, OR = 3.26, CI = 1.52 – 7.01, but similar across other locations. In addition, odds of pre-gaming were higher on AmED days as compared to non-AmED days, OR = 3.93, CI = 1.70 – 9.11. AmED use was unrelated to drinking game behavior, OR = 0.38, CI = 0.10 – 1.53. Odds of drinking with others as opposed to drinking alone were higher on AmED days, OR = 3.80, CI = 1.19 – 12.14.

Discussion: Overall, AmEDs are consumed socially and in potentially risky contexts. In combination with prior findings that AmED days are linked with heavier alcohol use and more harms, these findings support the unique nature of AmED use in predicting or maintaining potentially hazardous drinking patterns. The findings may aid in prevention efforts for AmED users. Information about the potential for risk related to drinking AmEDs could be incorporated in existing brief motivational interventions that deliver personalized feedback on drinking habits. Our findings suggest AmEDs are consumed in bars and clubs, while pre-gaming, and with other people. These contexts may be key topics in AmED-tailored intervention work. Because drinking in these environments is uniquely linked with poorer outcomes, users should be informed of their risk for experiencing harms not only by drinking AmEDs but also by drinking AmEDs in these known risky contexts.