Research paperEnvironmental contexts of combined alcohol and energy drink use: Associations with intoxication in licensed venues
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)
- et al.
Is alcohol mixed with energy drinks consumption associated with susceptibility to smoking?
Preventive Medicine
(2014) - et al.
Drinking patterns and risk behaviors associated with combined alcohol and energy drink consumption in college drinkers
Addictive Behaviors
(2011) - et al.
High rates of alcohol consumption and related harm at schoolies week: A portal study
Australian and New Zealand Journal of Public Health
(2014) - et al.
A comprehensive review of the effects of mixing caffeinated energy drinks with alcohol
Drug and Alcohol Dependence
(2015) Play space: Historical and socio-cultural reflections on drugs, licensed leisure locations, commercialisation and control
International Journal Of Drug Policy
(2004)Energy drinks, race, and problem behaviors among college students
Journal of Adolescent Health
(2008)- et al.
Re-framing ‘binge drinking’ as calculated hedonism: Empirical evidence from the UK
International Journal Of Drug Policy
(2008) - et al.
Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons
Addictive Behaviors
(2010) - et al.
The “high” risk of energy drinks
Journal of the American Medical Association
(2011) Food regulation policy options paper: The regulation of caffeine in foods
(2013)
Alcohol: No ordinary commodity – Research and public policy
Statistical power analysis for the behavioral sciences
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
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
Discovering statistics using SPSS
To what extent is intoxication associated with aggression in bars? A multilevel analysis
Journal of Studies on Alcohol and Drugs
Evaluating theories of alcohol-related aggression using observations of young adults in bars
Addiction
Making licensed venues safer for patrons: What environmental factors should be the focus of interventions?
Drug and Alcohol Review
Drunk and disorganised: Relationships between bar characteristics and customer intoxication in European drinking environments
International Journal of Environmental Research and Public Health
Environmental factors in drinking venues and alcohol-related harm: The evidence base for European intervention
Addiction
IBM SPSS statistics for Mac (Version Version 21.0)
Why (not) alcohol energy drinks? A qualitative study with Australian university students
Drug and Alcohol Review
A qualitative review of psychosocial risk factors associated with caffeinated alcohol use
Experimental and Clinical Psychopharmacology
Young Australians and the staging of intoxication and self-control
Journal of Youth Studies
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
Cited by (9)
Off the rails—Evaluating the nightlife impact of Melbourne, Australia's 24-h public transport trial
2019, International Journal of Drug PolicyCitation Excerpt :Observers were then instructed to focus on different areas of the venue to that of their observation partner to ensure data were independent and to ensure an accurate representation of the entire venue, rather than any one specific area (Droste et al., 2016). As per similar studies using this methodology, male/female pairs were utilized wherever possible to maximize safety of observers (Droste et al., 2016; Miller, Pennay, Jenkinson et al., 2013). To ensure observations remained covert, observers wore clothes consistent with those of usual patrons of the particular venue they were at, and were encouraged to behave as a normal customer of that venue would.
Bars, Nightclubs, and Cancer Prevention: New Approaches to Reduce Young Adult Cigarette Smoking
2017, American Journal of Preventive MedicineCitation Excerpt :Bars and nightclubs are a nexus for risk behavior among young adults. This may be due to the aggressive marketing of both tobacco and alcohol in bars,11,48,49 reinforcing effects of tobacco and alcohol, which increases the risk of addiction,50,51 or features of the physical and social environment that normalize risky behaviors (including other drug use, sexual risk taking).52–56 Conversely, bars and clubs pose opportunities for cancer prevention, addressing the cancer risk afforded by both tobacco and alcohol use.
Combined use of alcohol and energy drinks: Dose relationship with self-reported physiological stimulation and sedation side effects
2017, Addictive BehaviorsCitation Excerpt :Consumption of alcohol mixed with energy drinks (AmED) has become commonplace amongst young adults in the past decade (Brache, Thomas, & Stockwell, 2012; Pennay et al., 2015a), particularly in nightlife and party contexts (Droste, Miller, Pennay, Zinkiewicz, & Lubman, 2016a; Droste et al., 2016b; Peacock, Bruno, & Martin, 2013a; Pettigrew et al., 2015).
Alcohol mixed energy drink usage and risk-taking among college students in Western New York State
2022, Journal of American College HealthDisplacements of gender: Research on alcohol, violence and the night-time economy
2021, Journal of SociologyAlcohol mixed with energy drinks and intoxication
2020, Cultures of Intoxication: Key Issues and Debates