Fact Sheets

Caffeinated Alcoholic Beverages

Public Health Impact of Excessive Alcohol Use

Excessive alcohol consumption is responsible for over 79,000 deaths and 2.3 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 over half of the deaths and two-thirds of the YPLL due to excessive drinking², and is associated with many health and social problems, including alcohol-impaired driving, interpersonal violence, risky sexual activity, and unintended pregnancy.³
Most underage youth 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 youth 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 youth, 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 have experienced rapid growth in popularity since 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
Currently, more than 25 brands of CABs are sold in a variety of U.S. retail alcohol outlets, including many convenience stores.⁹
CABs are heavily marketed in youth-friendly media (e.g., on web sites with downloadable images) and with youth-oriented graphics and messaging (e.g., connected with extreme sports or other risk-taking behaviors).¹¹

Prevention Strategies

In 2008, thirteen State Attorneys General and the San Francisco, CA, City Attorney initiated an investigation of CABs, which resulted in negotiated settlements with two CAB producers, who agreed to remove all stimulants from their products.⁹
Because CABs may have higher alcohol content than beer, some states (e.g., Montana) have classified CABs as liquor, thereby limiting the locations where these beverages can be sold.¹²
States and communities are also developing educational strategies to alert consumers to the risks of mixing alcohol with energy drinks and CABs. One community has enacted an ordinance requiring retailers to post signs warning of the risks of CABs.¹³
Effective population-based strategies for preventing excessive alcohol consumption and related harms should also be implemented, including increasing alcohol excise taxes, limiting alcohol outlet density, and maintaining existing restrictions on days of sale.¹⁴
Youth exposure to alcohol marketing should also be reduced by lowering the voluntary industry standard governing the placement of alcohol advertising from the current 30% threshold to 15%, based on the proportion of the audience that is age 12-20 years.¹⁵

References

CDC. Alcohol-Related Disease Impact (ARDI) [database]. Available at http://apps.nccd.cdc.gov/ardi/Homepage.aspx. Accessed on May 26, 2010.
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. Morb Mortal Wkly Rep 2004; 53:866-870.
Naimi TS, Brewer RB, Mokdad A, Denny C, Serdula MK, Marks JS. Binge drinking among U.S. Adults. JAMA 2003; 289:70–5.
Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2006;119:76-85.
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.
Mintel International Group Ltd. Energy drinks. Chicago, IL: Mintel International Group Ltd; 2007.
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.
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.
California Department of Alcohol and Drug Programs. Alcoholic energy drinks. Available at: http://www.adp.ca.gov/youth/aed_index.shtml. Accessed on May 26, 2010.
M. Shanken Communications, Inc. The U.S. beer market: impact databank review and forecast, p. 533. New York, NY: M. Shanken Communications, Inc.; 2009.
Simon M, Mosher J. Alcohol, energy drinks, and youth: a dangerous mix. San Rafael, CA: Marin Institute; 2007.
Montana Code Annotated § 16-1-106 (8).
City of Thousand Oaks, CA. Ordinance No. 1528-NS, enacted November 17, 2009. Available at: http://www.adp.ca.gov/youth/pdf/aed_thousand_oaks_ord.pdf [PDF–163.2KB]. Accessed on May 26, 2010.
Centers for Disease Control and Prevention. Alcohol. Guide to community preventive services Web site. Available at http://www.thecommunityguide.org/alcohol/index.html. Accessed May 26, 2010.
Bonnie RJ, O’Connell ME, eds. Reducing underage drinking: a collective responsibility. Washington, DC: The National Academies Press; 2004.