Fact Sheets - Alcohol and Caffeine

Alcohol and Caffeine

Public Health Impact of Excessive Alcohol Use

• Excessive alcohol use is responsible for about 88,000 deaths in the United States each year¹ and $249 billion in economic costs in 2010.²
• Binge drinking (consuming 4 or more drinks per occasion for women or 5 or more drinks per occasion for men) is responsible for more than half of these deaths³ and three quarters of economic costs.²
• Binge drinking is also associated with many health and social problems, including alcohol-impaired driving, interpersonal violence, risky sexual activity, and unintended pregnancy.⁴
• Most people younger than age 21 who drink report binge drinking, usually on multiple occasions.⁵

Dangers of Mixing Alcohol and Caffeine

• The Dietary Guidelines for Americans cautions against mixing alcohol with caffeine.⁶
• When alcohol is mixed with caffeine, the caffeine can mask the depressant effects of alcohol, making drinkers feel more alert than they would otherwise. As a result, they may drink more alcohol and become more impaired than they realize, increasing the risk of alcohol-attributable harms.^6–10
• Caffeine has no effect on the metabolism of alcohol by the liver and thus does not reduce breath or blood alcohol concentrations (it does not “sober you up”) or reduce impairment due to alcohol consumption.⁷

Dangers of Mixing Alcohol and Energy Drinks

• Energy drinks typically contain caffeine, plant-based stimulants, simple sugars, and other additives.⁸
• Mixing alcohol with energy drinks is a popular practice, especially among young people in the United States.^11–13 In 2015, 13.0% of students in grades 8, 10, and 12 and 33.5% of young adults aged 19 to 28 reported consuming alcohol mixed with energy drinks at least once in the past year.^12,13
• In a study among Michigan high school students, those who binge drank were more than twice as likely to mix alcohol with energy drinks as non-binge drinkers (49.0% vs. 18.2%). Liquor was the usual type of alcohol consumed by students who reported mixing alcohol and energy drinks (52.7%).¹⁴
• Drinkers aged 15 to 23 who mix alcohol with energy drinks are 4 times more likely to binge drink at high intensity (i.e., consume 6 or more drinks per binge episode) than drinkers who do not mix alcohol with energy drinks.¹⁵
• Drinkers who mix alcohol with energy drinks are more likely than drinkers who do not mix alcohol with energy drinks to report unwanted or unprotected sex, driving drunk or riding with a driver who was intoxicated, or sustaining alcohol-related injuries.^7,16

Caffeinated Alcoholic Beverages

• Caffeinated Alcoholic Beverages (CABs) were premixed beverages popular in the 2000s¹⁷ that combined alcohol, caffeine, and other stimulants. They were malt or distilled spirits-based beverages and they usually had a higher alcohol content than beer (e.g., 12% alcohol by volume compared to 4% to 5% for beer).^7,17
• CABs were heavily marketed in youth-friendly media (e.g., social media) and with youth-oriented graphics and messaging that connected the consumption of these beverages with extreme sports or other risk-taking behaviors.¹⁸
• In November 2010, the US Food and Drug Administration (FDA) told the manufacturers of seven CABs that their drinks could no longer stay on the market in their current form, stating that “FDA does not find support for the claim that the addition of caffeine to these alcoholic beverages is ‘generally recognized as safe,’ which is the legal standard.”^7,19
• Producers of CABs responded by removing caffeine and other stimulants from their products. However some producers continued to sell these products without caffeine.^7,19

Prevention Strategies

• The Community Preventive Services Task Force recommends effective population-based strategies for preventing excessive alcohol consumption and related harms, including increasing alcohol excise taxes, limiting alcohol outlet density, and commercial host (dram shop) liability for service to underage or intoxicated customers.²⁰
• States and communities have also developed educational strategies to alert consumers to the risks of mixing alcohol with energy drinks. At least one community enacted an ordinance requiring retailers to post warning signs informing consumers of the risks of mixing alcohol and energy drinks.²¹
• Monitoring and reducing youth exposure to alcohol advertising through“no-buy” lists could also help reduce underage drinking. No-buy lists identify television programming that advertisers can avoid to improve compliance with the alcohol industry’s self-regulated alcohol marketing guidelines.²²

References

1. Centers for Disease Control and Prevention. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI) website. https://www.cdc.gov/ARDI. Accessed May 26, 2017.
2. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med. 2015;49(5):e73–e79.
3. Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014;11:130293. doi: http://dx.doi.org/10.5888/pcd11.130293.
4. World Health Organization. Global Status Report on Alcohol and Health—2014. Geneva, Switzerland: World Health Organization; 2014.
5. Esser MB, Clayton H, Demissie Z, Kanny D, Brewer RD. Current and binge drinking among high school students – United States, 1991–2015. MMWR. 2017;66:474-478.
6. US Department of Health and Human Services and US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th ed. Washington, DC US Department of Health and Human Services and US Department of Agriculture; 2015.
7. US Food and Drug Administration. Consumer Updates: Serious Concerns over Alcoholic Beverages with Added Caffeine website. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm233987.htm. Accessed May 26, 2017.
8. Marczinski CA, Fillmore MT. Energy drinks mixed with alcohol: what are the risks? Nutr Rev. 2014;72(suppl 1):98–107.
9. McKetin R, Coen A, Kaye S. A comprehensive review of the effects of mixing caffeinated energy drinks with alcohol. Drug Alcohol Depend. 2015;151:15–30.
10. Seifert SM, Schaechter JL, Hershorin ER, Lipshultz SE. Health effects of energy drinks on children, adolescents, and young adults. Pediatrics. 2011;127(3):511–528.
11. Kponee KZ, Siegel M, Jernigan DH. The use of caffeinated alcoholic beverages among underage drinkers: results of a national survey. Addict Behav. 2014;39(1):253–258.
12. Johnson LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the Future: National Survey Results on Drug Use, 1975–2015. 2015 Overview: Key Findings on Adolescent Drug Use. Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2016.
13. Johnson LD, O’Malley PM, Bachman JG, Schulenberg JE, Miech RA. Monitoring the Future: National Survey Results on Drug Use, 1975–2015. Volume 2: College Students and Adults Ages 19–55. Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2016.
14. Gonzales KR, Largo TW, Miller C, Kanny D, Brewer RD. Consumption of alcoholic beverages and liquor consumption by Michigan high school students, 2011. Prev Chronic Dis. 2015;12:150290. doi: http://dx.doi.org/10.5888/pcd12.150290s.
15. Emond JA, Gilbert-Diamond D, Tanski SE, Sargent JD. Energy drink consumption and the risk of alcohol use disorder among a national sample of adolescents and young adults. J Pediatr. 2014;165(6):1194–200.
16. Roemer A, Stockwell T. Alcohol mixed with energy drinks and risk of injury: a systematic review. J Stud Alcohol Drugs. 2017;78(2):175–183.
17. M. Shanken Communications, Inc. The U.S. Beer Market: Impact Databank Review and Forecast. New York, NY: M. Shanken Communications, Inc.; 2009:533.
18. Simon M, Mosher J. Alcohol, Energy Drinks, and Youth: A Dangerous Mix. San Rafael, CA: Marin Institute; 2007.
19. US Food and Drug Administration. Caffeinated Alcoholic Beverages Website. https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm190366.htm. Accessed May 26, 2017.
20. Community Preventive Services Task Force. The Guide to Community Preventive Services. Excessive Alcohol Consumption website. https://www.thecommunityguide.org/topic/excessive-alcohol-consumption. Accessed May 26, 2017.
21. City of Thousand Oaks, CA. The City of Thousand Oaks, CA Municipal Code. Title 5. Chapter 27. Sec. 5-27.01–5-27.03.
22. Ross CS, Brewer RD, Jernigan DH. The potential impact of a “no-buy” list on youth exposure to alcohol advertising on cable television. J Stud Alcohol Drugs. 2016;77:7–16.