Fact Sheets - Caffeine and Alcohol

Caffeine and Alcohol

Public Health Impact of Excessive Alcohol Use

• Excessive alcohol consumption is responsible for about 88,000 deaths and 2.5 million years of potential life lost (YPLL) in the United States each year.¹
• Binge drinking (consuming 4 or more drinks per occasion for women; 5 or more drinks per occasion for men) is responsible for more than half of the deaths and two-thirds of the YPLL due to excessive drinking,² and is associated with many health and social problems, including alcohol-impaired driving, interpersonal violence, risky sexual activity, and unintended pregnancy.³
• Most people under age 21 who drink report binge drinking, usually on multiple occasions.⁴

Dangers of Mixing Alcohol and Energy Drinks

• Energy drinks are beverages that typically contain caffeine, other plant-based stimulants, simple sugars, and other additives.⁵ They are very popular among young people and are regularly consumed by 31% of 12- to 17-year-olds and 34% of 18- to 24-year-olds.⁶
• When alcoholic beverages are mixed with energy drinks, a popular practice among young people, the caffeine in these drinks can mask the depressant effects of alcohol.⁷ At the same time, caffeine has no effect on the metabolism of alcohol by the liver and thus does not reduce breath alcohol concentrations or reduce the risk of alcohol-attributable harms.⁷
• Drinkers who consume alcohol mixed with energy drinks are 3 times more likely to binge drink (based on breath alcohol levels) than drinkers who do not report mixing alcohol with energy drinks.⁸
• Drinkers who consume alcohol with energy drinks are about twice as likely as drinkers who do not report mixing alcohol with energy drinks to report being taken advantage of sexually, to report taking advantage of someone else sexually, and to report riding with a driver who was under the influence of alcohol.⁵

Caffeinated Alcoholic Beverages

• Caffeinated Alcoholic Beverages (CABs) are premixed beverages that combine alcohol, caffeine, and other stimulants. They may be malt- or distilled-spirits-based and usually have higher alcohol content than beer (i.e., 5%–12% on average for CABs and 4%–5% for beer). The caffeine content in these beverages is usually not reported.⁹
• CABs experienced a rapid growth in popularity after being introduced into the marketplace. For example, two leading brands of CABs together experienced a 67-fold increase in sales, from 337,500 gallons in 2002 (the first year of significant CAB production) to 22,905,000 gallons in 2008.¹⁰
• CABs were heavily marketed in youth-friendly media (e.g., on Web sites with downloadable images) and with youth-oriented graphics and messaging (i.e., connected with extreme sports or other risk-taking behaviors).¹¹
• In November 2010, the 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 "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."¹²
• Producers of CABs subsequently removed caffeine and other stimulants from their products.¹²

Prevention Strategies

• States and communities have developed educational strategies to alert consumers to the risks of mixing alcohol with energy drinks. One community has enacted an ordinance requiring retailers to post signs warning of these risks.¹³
• Effective population-based strategies for preventing excessive alcohol consumption and related harms include increasing alcohol excise taxes, limiting alcohol outlet density, and commercial host (dram shop) liability for service to underage or intoxicated customers.¹⁴
• Youth exposure to alcohol marketing could be reduced by improving industry compliance with the voluntary industry standard governing the placement of alcohol advertising, and lowering the youth-audience threshold from the current 28.4% to 15% as recommended by the Institute of Medicine.¹⁵

References

1. Centers for Disease Control and Prevention. Alcohol-Related Disease Impact (ARDI).
2. Stahre M, Brewer R, Naimi T, Miller J, et al. Alcohol-Attributable Deaths and Years of Potential Life Lost due to Excessive Alcohol Use in the U.S. MMWR. 2004; 53:866-870.
3. Naimi TS, Brewer RB, Mokdad A, Denny C, Serdula MK, Marks JS. Binge drinking among U.S. Adults. JAMA. 2003; 289:70–5.
4. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics. 2006;119:76-85.
5. O’Brien MC, McCoy TP, Rhode SD, Wagoner A, Wolfson M. Caffeinated cocktails; energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Acad Emerg Med. 2008;15(5):453-460.
6. Mintel International Group Ltd. Energy Drinks. Chicago, IL: Mintel International Group Ltd; 2007.
7. Ferreira SE, Tulio de Mello M, Pompeia S, Oliveria de Souza-Formigoni ML. Effects of energy drink ingestion on alcohol intoxication. Alcohol Clin Exp Res. 2006;30(4):598-605.
8. Thombs DL, O’Mara RJ, Tsukamoto M, Rossheim Me, Weiler RM, Merves ML, Goldberger BA. Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons. Addictive Behaviors. 2010;35;325-330.
9. California Department of Alcohol and Drug Programs. Alcoholic Energy Drinks Web site.
10. M. Shanken Communications, Inc. The U.S. Beer Market: Impact Databank Review and Forecast. New York, NY: M. Shanken Communications, Inc.; 2009:533.
11. Simon M, Mosher J. Alcohol, Energy Drinks, and Youth: A Dangerous Mix. San Rafael, CA: Marin Institute; 2007.
12. U.S. Food and Drug Administration. Update on Caffeinated Alcoholic Beverages Web site.
13. City of Thousand Oaks, CA. The City of Thousand Oaks, CA, Municipal Code, Sec. 5-27.
14. Guide to Community Preventive Services. Preventing Excessive Alcohol Consumption Web site.
15. Bonnie RJ, O’Connell ME, eds. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: The National Academies Press; 2004.