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

https://doi.org/10.1016/j.drugpo.2016.06.016Get rights and content

Abstract

Background

Environmental 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.

Methods

Structured 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.

Results

898 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.

Conclusion

AmED 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.

Introduction

Consuming alcohol mixed with energy drinks (AmED) has increased in popularity in the past decade, and has attracted attention from researchers and policy makers attempting to quantify and prevent potential increases in alcohol related harms (Arria and O’Brien, 2011, Australian and New Zealand Food Regulation Standing Committee, 2013, Pennay and Lubman, 2012b). Compared to consumers of alcohol only, AmED consumers have been linked to higher levels of alcohol intoxication, involvement in drink driving and driving without a seatbelt, risky sex, susceptibility to tobacco smoking, higher rates of alcohol dependence, illicit substance use, and involvement in physical aggression (Azagba and Sharaf, 2014, Brache and Stockwell, 2011, Linden and Lau-Barraco, 2014, Miller, 2008, O’Brien et al., 2013, Peacock et al., 2013b, Thombs et al., 2010).

However, the nature of the relationship between AmED consumption and these outcomes has been difficult to quantify. Experimental models have demonstrated that AmED dosage can produce increased desire for more alcohol (Marczinski et al., 2013, McKetin and Coen, 2014), increased subjective ratings of stimulation (Marczinski, Fillmore, Bardgett, & Howard, 2011), and a reduced perception of the intoxicating effects of alcohol (Marczinski & Fillmore, 2006), all of which imply that AmED use may promote greater alcohol intake in voluntary consumption scenarios. However, within-subjects findings of actual self-reported consumption rates are mixed, with some studies reporting higher alcohol intake during AmED sessions (Brache and Stockwell, 2011, Peacock et al., 2013a, Price et al., 2010), whereas others report no difference in alcohol intake, or higher intake during sessions of alcohol only (de Haan et al., 2012, Verster et al., 2016, Woolsey et al., 2010).

In order to explore these inconsistencies, some researchers have turned to the investigation of individual consumer factors such as risk-taking propensity and motives for AmED consumption, with results indicating that AmED consumers are a heterogeneous group whose consumption outcomes are strongly linked to motives, expectancies, and other risk-taking behaviours (Droste et al., 2014, Mallett et al., 2014, Peacock et al., 2015a, Peacock et al., 2015b). Other commentators (e.g. Miller, 2013, Pennay and Lubman, 2012a) have called for an exploration of AmED consumption contexts to determine the extent to which environmental factors such as the drinking environment, promotions, and venue characteristics are associated with AmED use. To date, there has been a lack of research directly addressing the consumption contexts of AmED use.

Given that consumption contexts have been demonstrated as powerful predictors and moderators of alcohol and illicit substance use (Hughes et al., 2011, Hughes et al., 2012, Lindsay, 2009, Measham, 2004a, Measham, 2004b), studies that more directly address contexts of AmED use are important in order to understand the relationship between AmED use and drinking environments, and particularly the relationship between AmED consumption, alcohol intoxication and behavioural or social practices.

Section snippets

What is known about AmED contexts?

Only five papers have addressed the environmental contexts in which AmED are consumed (Jones et al., 2012, Peacock et al., 2013a, Pennay and Lubman, 2012a, Price et al., 2010, Wells et al., 2013), and three of these addressed context indirectly (Jones et al., 2012, Peacock et al., 2013a, Price et al., 2010). Overall, it was reported in these papers (or the research design indirectly assumed) that the majority of AmED consumption takes place either prior to, or during, attendance at licensed

Why are consumption contexts important?

The level of patron intoxication in a licensed venue is a powerful predictor of frequency of barroom violence and aggressive incidents (Graham, Osgood, Wells, & Stockwell, 2006). Observational research conducted in licensed venues in Canada and the UK has implicated a number of environmental characteristics in increased alcohol intoxication and subsequent incidents of harm. In a large-scale study assessing environmental factors in venues in four European countries, the proportion of younger

Methods

Observational studies are useful for expanding knowledge of emergent or novel consumption behaviors, and are free from the artificial constraints of experimental research and the potential for social desirability, inaccurate self-report, or other response biases inherent in survey research (Graham et al., 2000, Pennay and Lubman, 2012a, Tomsen, 1997). In situ venue observations have been used successfully as a field-study methodology in several Australian nightlife studies (Homel et al., 2004,

Results

In total, 68 unique venues were observed during the data collection period. The Melbourne team visited the largest number of venues (n = 26), followed by Sydney (n = 17), Perth (n = 12), Wollongong (n = 7) and Geelong (n = 6). In total, 898 hourly venue observations were conducted across all sites. The largest proportion of observations were conducted in bar type venues (43.5%); the remainder were conducted in “nightclub” type venues (31.6%) and “large, mainstream pubs” (24.8%).

Discussion

This study is the first to report on structured event-level observation of AmED consumption in licensed venues. Results drawn from venues in five Australian cities reinforce preliminary findings that AmED consumption is ubiquitous and normalised in the licensed venues of busy night-time entertainment districts (Pennay & Lubman, 2012a). Energy drinks were available for purchase in all but one venue sampled for this study, and consumption of AmEDs was observed during one-third of hourly

Implications

The venue-level findings of this study reflect the widely reported consumer-level trends for AmED use: AmED is positively associated with increased intoxication, riskier consumption practices, and a younger demographic of alcohol consumers (McKetin et al., 2015, Pennay et al., 2015a, Peacock et al., 2013b). However, despite this association, the current findings do not indicate that the presence of AmED use significantly contributes to overall intoxication across the range of venues after

Limitations

Although not a limitation of the methodology, the findings of this study are limited by the relatively low prevalence of AmED drinkers in venues where AmED use was observed (approximately 6% of patrons), although prevalence was somewhat higher in a small number of venues. Given this low prevalence, it may be statistically unlikely to find a large association between AmED and overall patron intoxication after accounting for other environmental variables, even when a bivariate association exists.

Conclusion

The current model suggests that AmED use is strongly associated with intoxication in licensed venues. However, AmED use was not associated with patron intoxication when environmental factors were considered.

Environmental context is an important element in the consumption of AmED. As such, future efforts to reduce alcohol-related harms associated with AmED use may be best focused upon time-tested measures which effectively reduce harms in nightlife contexts. Historically, restricted venue

Conflict of interest

This study was supported by funding from the National Drug Law Enforcement Research Fund (NDLERF), Australian Research Council (ARC; ID LP110200699) and Victorian Health Promotion Fund (VicHealth). Nicolas Droste is funded by an ARC PhD scholarship (LP110200699) and Amy Pennay is funded by an NHMRC Early Career Fellowship (APP1069907).

References (51)

  • T. Babor et al.

    Alcohol: No ordinary commodity – Research and public policy

    (2010)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • L. de Haan et al.

    Effects of consuming alcohol mixed with energy drinks versus consuming alcohol only on overall alcohol consumption and negative alcohol-related consequences

    International Journal of General Medicine

    (2012)
  • N. Droste et al.

    Combined alcohol and energy drink use: Motivations as predictors of consumption patterns, risk of alcohol dependence and experience of injury and aggression

    Alcohol: Clinical and Experimental Research

    (2014)
  • A. Field

    Discovering statistics using SPSS

    (2013)
  • K. Graham et al.

    To what extent is intoxication associated with aggression in bars? A multilevel analysis

    Journal of Studies on Alcohol and Drugs

    (2006)
  • K. Graham et al.

    Evaluating theories of alcohol-related aggression using observations of young adults in bars

    Addiction

    (2000)
  • R. Homel et al.

    Making licensed venues safer for patrons: What environmental factors should be the focus of interventions?

    Drug and Alcohol Review

    (2004)
  • K. Hughes et al.

    Drunk and disorganised: Relationships between bar characteristics and customer intoxication in European drinking environments

    International Journal of Environmental Research and Public Health

    (2012)
  • K. Hughes et al.

    Environmental factors in drinking venues and alcohol-related harm: The evidence base for European intervention

    Addiction

    (2011)
  • IBM Corp

    IBM SPSS statistics for Mac (Version Version 21.0)

    (2012)
  • S. Jones et al.

    Why (not) alcohol energy drinks? A qualitative study with Australian university students

    Drug and Alcohol Review

    (2012)
  • A.N. Linden et al.

    A qualitative review of psychosocial risk factors associated with caffeinated alcohol use

    Experimental and Clinical Psychopharmacology

    (2014)
  • J. Lindsay

    Young Australians and the staging of intoxication and self-control

    Journal of Youth Studies

    (2009)
  • K.A. Mallett et al.

    Are all alcohol and energy drink users the same? Examining individual variation in relation to alcohol mixed with energy drink use, risky drinking, and consequences

    Psychology of Addictive Behaviors

    (2014)
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