Amy Pennay

'High' Risk? A Systematic Review of the Acute Outcomes of Mixing Alcohol with Energy Drinks

AIMSnAlcohol mixed with energy drinks (AmED) is a relatively new consumption trend generating increasing concern regarding potential adverse effects. Despite the political and health imperative, there has been no systematic and independent synthesis of the literature to determine whether or not AmED offers additional harms relative to alcohol. The aim of this study was to review the evidence about whether co-consumption of energy drinks and alcohol, relative to alcohol alone, alters: (i) physiological, psychological, cognitive and psychomotor outcomes; (ii) hazardous drinking practices; and (iii) risk-taking behaviour.nnnMETHODSnPubmed, PsycInfo and Embase databases were searched until May 2013 for papers outlining descriptive, observational analytical and human experimental studies which compared target outcomes for AmED versus alcohol consumers (between-subjects), or AmED versus alcohol consumption (within-subjects). Odds ratios were calculated for target outcomes following screening, data extraction and quality assessment.nnnRESULTSnData were extracted from 19 papers. Analyses typically revealed increased odds of self-reported stimulation-based outcomes and decreased odds of sedation-based physiological and psychological outcomes relative to when alcohol was consumed alone, as indicated by rigorous cross-sectional descriptive research. These findings typically have not been reflected in experimental research, due possibly to the low doses administered relative to typical self-reported real-life intake. AmED consumers generally report more hazardous alcohol consumption patterns and greater engagement in risk-taking behaviour than alcohol consumers. While most studies had equivocal findings, two studies showed lower odds of risk-taking behaviour for AmED relative to alcohol drinking sessions but limitations with respect to the outcome measures used restrict conclusions with regard to the behavioural outcomes of AmED use.nnnCONCLUSIONSnMixing alcohol with energy drinks may exert a dual effect, increasing stimulation-based effects and reducing sedation-based outcomes; the clinical severity and dose threshold has not been established. At this stage it is unclear whether these changes in the nature of intoxication translate into greater alcohol intake and risk-taking behaviour.

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

BACKGROUNDnCoconsumption of alcohol with energy drinks (AED) is becoming increasingly popular among adolescents and young adults and has been associated with a range of harms. Motivations related to determined drunkenness and hedonistic drinking are potentially important in explaining both alcohol and AED consumption, given that a relationship has been identified between AED use and heavy alcohol consumption. This study aimed to explore motives for combined AED consumption, as well as their relationship with alcohol dependence and experiences of harm and aggression.nnnMETHODSnStudents (n = 594) enrolled at Deakin University, Victoria, Australia, completed an anonymous online survey in 2012. Approximately two-thirds of the sample (66.5%) were female, and the mean age was 22.3 (SD = 4.5), consistent with 2012 Deakin University enrollment.nnnRESULTSnPrincipal axis factor analysis of 14 items measuring motivations for AED use identified 4 factors, categorized as hedonistic, social, energy/endurance, and intoxication-reduction motives. Multinomial and binary logistic regression analyses demonstrated that hedonistic motives for AED use significantly predicted increases in alcohol and energy drink coconsumption during AED episodes, risk of alcohol dependence, as well as experiencing harm and aggression. Intoxication-reduction motives significantly predicted harm outcomes.nnnCONCLUSIONSnHedonistic motives specific to sensation and pleasure ideals are implicated in negative consequences associated with coconsumption of alcohol and energy drinks. Further, consumers who reported using AEDs to reduce alcohol intoxication were at increased risk of negative outcomes, a finding indicating that consumer knowledge of the effects of AED use may be limited.

A systematic review of interventions for co-occurring substance use disorder and borderline personality disorder

Rates of borderline personality disorder (BPD) among individuals with substance use disorder (SUD) are estimated to be as high as 65%. Such elevated rates present considerable challenges for drug treatment services given that individuals with co-occurring SUD and BPD have higher rates of relapse, treatment noncompliance, and poorer outcomes than those with either diagnosis alone. A systematic review investigating current treatment options for co-occurring SUD and BPD was conducted using Medline and PsycINFO. Randomized controlled trials were the focus. Six studies were included that examined the use of three psychosocial therapies: dialectical behavior therapy, dual focused schema therapy and dynamic deconstructive psychotherapy. Despite all studies demonstrating some treatment gains over time, there is currently insufficient evidence to recommend one treatment over another. Further research is needed to examine effective treatment options for co-occurring SUD and BPD, especially those that are likely to be applicable in mainstream drug treatment settings.

'Wide-awake drunkenness'? Investigating the association between alcohol intoxication and stimulant use in the night-time economy

AIMSnWe tested whether patrons of the night-time economy who had co-consumed energy drinks or illicit stimulants with alcohol had higher blood alcohol concentration (BAC) levels than patrons who had consumed only alcohol.nnnDESIGNnStreet intercept surveys (nu2009=u20094227) were undertaken between 9 p.m. and 5 a.m. over a period of 7 months.nnnSETTINGnInterviews were undertaken with patrons walking through entertainment precincts, queuing to enter venues or exiting venues in five Australian cities.nnnPARTICIPANTSnThe response rate was 92.1%; more than half the study sample was male (60.2%) and the median age was 23 years (range 18-72).nnnMEASUREMENTSnData were collected on demographics, length of drinking session, venue types visited, types and quantity of alcohol consumed and other substance use. A BAC reading was recorded and a subsample of participants was tested for other drug use.nnnFINDINGSnCompared with the total sample (0.068%), illicit stimulant consumers (0.080%; Pu2009=u20090.004) and energy drink consumers (0.074%; Pu2009<u20090.001) had a significantly higher median BAC reading, and were more likely to engage in pre-drinking (65.6, 82.1 and 77.6%, respectively, Pu2009<u20090.001) and longer drinking sessions (4, 5 and 4.5 hours, respectively, Pu2009<u20090.001). However, stimulant use was not associated independently with higher BAC in the final multivariable model (illicit stimulants Pu2009=u20090.198; energy drinks Pu2009=u20090.112). Interaction analyses showed that stimulant users had a higher BAC in the initial stages of the drinking session, but not after 4-6 hours.nnnCONCLUSIONSnWhile stimulant use does not predict BAC in and of itself, stimulants users are more likely to engage in prolonged sessions of heavy alcohol consumption and a range of risk-taking behaviours on a night out, which may explain higher levels of BAC among stimulants users, at least in the initial stages of the drinking session.

A comparative study of blood alcohol concentrations in Australian night-time entertainment districts

INTRODUCTION AND AIMSnThere is little research describing how intoxication levels change throughout the night in entertainment districts. This research aims to describe levels of alcohol intoxication across multiple Australian metropolitan and regional nightlife districts.nnnDESIGN AND METHODSnThis study was conducted in the night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia. Data collection occurred approximately fortnightly in each city on a Friday or Saturday night between 8u2009pm and 5u2009am. Brief structured interviews (3-10u2009min) and breathalyser tests were undertaken in busy thoroughfares over six months.nnnRESULTSnOf the 7037 individuals approached to participate in the study, 6998 [61.8% male, mean age 24.89 years (standard deviation 6.37; range 18-73)] agreed to be interviewed. There was a linear increase in blood alcohol concentration (BAC) levels throughout the night. Post hoc testing revealed significantly more highly intoxicated participants (i.e. BAC above 0.10u2009mg of alcohol per 100u2009mL of blood) after midnight (Pu2009<u20090.05). The overall mean BAC was 0.06u2009mg/100u2009mL. Men were more intoxicated than women earlier in the night, but gender differences disappeared by 3u2009am. There was no age differences in intoxication earlier in the night, but after midnight, patrons over the age of 21 showed increasing BAC levels.nnnDISCUSSION AND CONCLUSIONSnThere is a consistent trend across the cities of high to very high levels of intoxication later in the night, with trends after midnight being significantly different to those before.

High rates of alcohol consumption and related harm at schoolies week: a portal study

Objective: To investigate alcohol consumption, substance use and risky and harmful behaviour among young people attending ‘schoolies’ week in Victoria.

Drug use in Australian nightlife settings: estimation of prevalence and validity of self-report.

AIMSnThis study aimed to (1) estimate the prevalence of illicit drug use in night-time entertainment districts across five major cities in Australia; and (2) validate self-reported drug use using biochemical marker oral swabs.nnnDESIGNnStreet intercept surveys and oral drug swabs conducted over a 7-month period during 2011-12.nnnSETTINGnThe night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia, between the hours of 10u2009p.m. and 5u2009a.m.nnnPARTICIPANTSnA total of 7581 individuals agreed to participate in the survey (93% response rate). More than half (62%) the sample was male, with a median age of 22u2009years (range 18-73).nnnMEASUREMENTSnPatrons were approached in thoroughfares and while entering and leaving licensed venues. Data collected included demographics and current session alcohol and other substance use. Drug swabs (nu2009=u2009401) were performed with a subsample of participants.nnnFINDINGSnApproximately 9% [95% confidence interval (CI)u2009=u20097-12%] of participants self-reported consumption of illicit or non-prescribed pharmaceutical drugs prior to interview; of those, 81% identified psychostimulants as the drug used. One in five drug swabs returned a positive result, with psychostimulants the most commonly detected drugs (15%; 95% CIu2009=u200912-19%). Kappa statistics indicate agreement between self-report of any illicit drug and a positive drug swab is in the slight range [κu2009=u20090.12 (95% CIu2009=u20090.05-0.20) Pu2009=u20090.000].nnnCONCLUSIONSnSelf-report findings suggest drug use in Australian nightlife is common, although still very much a minority past-time. Drug swabs indicate a higher prevalence of use (20%) than self-report (9%), which suggests that self-reported drug use may not be reliable in this context.

An Examination of the Prevalence, Consumer Profiles, and Patterns of Energy Drink Use, With and Without Alcohol, in Australia

BACKGROUNDnThere has been a significant growth in the energy drink (ED) market in Australia and around the world; however, most research investigating the popularity of ED and alcohol and energy drink (AED) use has focused on specific subpopulations such as university students. The aim of this study was to estimate the prevalence, consumption patterns, and sociodemographic correlates of ED and combined AED use among a representative Australian population sample.nnnMETHODSnA computer-assisted telephone interview survey (n = 2,000) was undertaken in March-April 2013 of persons aged 18 years and over. Half of the interviews were obtained through randomly generated landline telephone numbers and half through mobile phones. Approximately half of the sample was female (55.5%; n = 1,110) and the mean age of participants was 45.9 (range 18 to 95, SD 20.0).nnnRESULTSnLess than 1 in 6 Australians reported ED use (13.4%, n = 268) and 4.6% (n = 91) reported AED use in the past 3 months. Majority of ED and AED users consumed these beverages monthly or less. ED and AED users are more likely to be aged 18 to 24 years, live in a metropolitan area, and be moderate risk or problem gamblers. AED consumers are more likely to report moderate levels of psychological distress.nnnCONCLUSIONSnOur findings in relation to problem gambling and psychological distress are novel and require further targeted investigation. Health promotion strategies directed toward reducing ED and AED use should focus on young people living in metropolitan areas and potentially be disseminated through locations where gambling takes place.

Self‐Reported Risk‐Taking Behavior During Matched‐Frequency Sessions of Alcohol Versus Combined Alcohol and Energy Drinks Consumption: Does Co‐Ingestion Increase Risk‐Taking?

BACKGROUNDnEmerging evidence indicates that consumers of alcohol mixed with energy drink (AmED) self-report lower odds of risk-taking after consuming AmED versus alcohol alone. However, these studies have been criticized for failing to control for relative frequency of AmED versus alcohol-only consumption sessions. These studies also do not account for quantity of consumption and general alcohol-related risk-taking propensity. The aims of the present study were to (i) compare rates of risk-taking in AmED versus alcohol sessions among consumers with matched frequency of use and (ii) identify consumption and person characteristics associated with risk-taking behavior in AmED sessions.nnnMETHODSnData were extracted from 2 Australian community samples and 1 New Zealand community sample of AmED consumers (nxa0=xa01,291). One-fifth (21%; nxa0=xa0273) reported matched frequency of AmED and alcohol use.nnnRESULTSnThe majority (55%) of matched-frequency participants consumed AmED and alcohol monthly or less. The matched-frequency sample reported significantly lower odds of engaging in 18 of 25 assessed risk behaviors in AmED versus alcohol sessions. Similar rates of engagement were evident across session type for the remaining behaviors, the majority of which were low prevalence (reported by <15%). Regression modeling indicated that risk-taking in AmED sessions was primarily associated with risk-taking in alcohol sessions, with increased average energy drink (ED) intake associated with certain risk behaviors (e.g., being physically hurt, not using contraception, and driving while over the legal alcohol limit).nnnCONCLUSIONSnBivariate analyses from a matched-frequency sample align with past research showing lower odds of risk-taking behavior after AmED versus alcohol consumption for the same individuals. Multivariate analyses showed that risk-taking in alcohol sessions had the strongest association with risk-taking in AmED sessions. However, hypotheses of increased risk-taking post-AmED consumption were partly supported: Greater ED intake was associated with increased likelihood of specific behaviors, including drink-driving, sexual behavior, and aggressive behaviors in the matched-frequency sample after controlling for alcohol intake and risk-taking in alcohol sessions. These findings highlight the need to consider both personal characteristics and beverage effects in harm reduction strategies for AmED consumers.

Hello Sunday Morning: Alcohol, (non)consumption and selfhood

BACKGROUNDnHello Sunday Morning (HSM) is an online program that encourages people to commit to a period of non-drinking and blog about their experiences. The purpose of this paper is to explore how HSM members negotiated their periods of abstention, with a focus on how not drinking influenced their narratives of selfhood.nnnMETHODSnThematic analysis was undertaken of 2844 blog posts from 154 Victorians who signed up to HSM in 2013 or 2014.nnnRESULTSnAnalysis revealed three key narratives of selfhood offered by participants: (1) abstinence resulting in a disrupted sense of self, (2) non-consumption facilitating the development of a new healthy self, and (3) anti-consumption facilitating the development of a resistant self.nnnCONCLUSIONnIndividuals construct and maintain their sense of self through consumption (or non-consumption) activities, and this occurs within the broader context of the relationship between selfhood, consumption and culture. HSM members developed narratives of self by drawing on a range of wider discursive structures concerning pleasure, healthism and resistance. The typologies of non-drinking selves identified in this paper could be disseminated through platforms such as HSM to support people who are new to non-drinking in choosing how they might construct and enact alternative selfhoods in contexts where alcohol consumption is deeply embedded.