Scientific Research Project 2

JOURNAL OF APPLIED SPORT PSYCHOLOGY, 22: 65–71, 2010 Copyright C© Association for Applied Sport Psychology ISSN: 1041-3200 print / 1533-1571 online DOI: 10.1080/10413200903403224

Athletes and Energy Drinks: Reported Risk-Taking and Consequences from the Combined Use of Alcohol

and Energy Drinks

CONRAD WOOLSEY

Oklahoma State University

ALEX WAIGANDT

University of Missouri, Columbia

NIELS C. BECK

University of Missouri Medical School

This study measured athletes’ alcohol, energy drink, and combined-use. It also compared athletes’ reported risk-taking and consequences while using alcohol-only and in combination with energy drinks. From the total sample of 401 intercollegiate student-athletes, 315 (78%) used alcohol, 150 (37%) combined alcohol with energy drinks, and 194 (48%) used energy drinks (EDs) without alcohol. Ninety-two percent of drinkers participated in binge drinking. Sixty-one percent of combined users participated in high risk “energy binge” drinking episodes (using 3+ EDs on one occasion). Results indicated combined users (n = 150) consumed significantly more alcohol and had riskier drinking habits (e.g., heavy binge drinking) than athletes who used alcohol only (n = 165). The combined use of alcohol and energy drinks could potentially contribute to increased risk-taking and negative consequences. Results suggest a possible need to include information about energy drinks in existing athlete alcohol education and prevention programs.

Since the introduction of Red Bull R© in the USA in 1997, energy drink (ED) use has increased exponentially. Red Bull sales alone rose from nearly 1 billion cans in 2000 to over 3 billion in 2006 (Red Bull GmbH, 2008). The energy drink market has expanded rapidly with sales increasing from $200 million in 2002 to $3.5 billion in 2006 (Reissig, Strain, & Griffiths, 2009). People have been known to use caffeine and other stimulants to improve athletic performance and recreationally with alcohol in an attempt to reduce alcohol’s depressant effects (Ferreira, Mello, Pompeia, & Souza-Formigoni, 2006). The concept of using stimulants with depressants is nothing new, but evidence suggests an increase in this behavior due to the proliferation of energy drinks (Malinauskas, Aeby, Overton, Carpenter-Aeby, &

Received 20 March 2008; accepted 26 June 2009. Address correspondence to Conrad Woolsey, Oklahoma State University, 2107 Main Hall, 700 North

Greenwood Avenue, Tulsa, OK 74106. E-mail: [email protected]

65

66 C. WOOLSEY ET AL.

Barber-Heidal, 2007; O’Brien, McCoy, Rhodes, Wagoner, & Wolfson, 2008). Athletes are constantly bombarded with messages stating energy drinks improve performance and mix well with sporting events. As witnessed by widespread use and positive athlete testimonials (e.g., 5-hour energy commercials), energy drinks appear to be perceived as safe and socially acceptable. The reality is that energy drinks and the herbal ingredients found within them are unregulated by the Food and Drug Administration and have not been recognized as safe (Food & Drug Administration, 2003). From a health standpoint, energy drinks do not mix well with exercise and have been linked to seizures, stroke, heart problems, and deaths (Iyadurai & Chung, 2007; Kapner, 2004; Malinauskas et al., 2007; Walsh, Marquardt, & Albertson, 2006; Worrall, Phillips, & Henderson, 2005).

Among college students, athletes have been identified as the heaviest users and most at-risk for serious problems associated with alcohol (Leichliter, Meilman, Presley, & Cashin, 1998; Nelson & Wechsler, 2001). Research indicates that college athletes participate in more alcohol- related risk-taking and experience more negative consequences from using alcohol compared to other college students (Ford, 2007; Leichliter et al., 1998; Wechsler, Davenport, Dowdall, Grossman, & Zanakos, 1997). Because athletes have been identified as an at-risk group for increased problems due to alcohol use, this study was designed to investigate how energy drinks affect the existing problems. The first purpose of this study was to measure athletes’ alcohol, energy-drink-only, and combined-use consumption rates. The second purpose was to compare athletes’ reported risk-taking and consequences when they used alcohol-only compared to when they combined alcohol-only and energy drinks.

METHOD

Participants

In the Fall of 2006, a total of 401 of 456 registered intercollegiate student-athletes from every men’s and women’s sport offered at a large Midwestern Division I university voluntarily participated in the study. The study used the Quick Drink Screen (QDS; Sobell, Agrawal, Sobell, Leo, Young, Cunningham et al., 2003) for alcohol use and a modified version for com- bined and energy-drink-only use to determine quantity-frequency information. Two modified versions of the Brief Comprehensive Effects of Alcohol (B-CEOA; Ham, Stewart, Norton, & Hope, 2005) compared athletes’ reported risk-taking behaviors and consequences when using alcohol and combining.

The QDS quantity-frequency sample (N = 401) consisted of 257 male and 144 female athletes with an average age of 19.80 years. Descriptive statistics from the QDS instruments indicated that 150 (37%) athletes combined alcohol with energy drinks. After data screening, 18 cases of combined users were removed for missing or incomplete data on the expectancy measures used for hypothesis testing. The combined-use sample (n = 132) contained 91 men (68.9%) and 41 women (31.1%) with an average age of 20.0 (SD = 1.30) years. Permission was obtained from the campus Institutional Review Board and the intercollegiate athletics department. Participants were recruited as entire teams at designated meetings. All coaches and personnel were removed from the area to protect the athletes’ privacy. Participation was confidential and voluntary with no consequences for not participating.

Measures

The QDS is a quantity-frequency and daily estimation measure that provides a retrospective estimate of a person’s average alcohol consumption over the past year. The QDS contains four

RISKS OF ATHLETE ALCOHOL AND ENERGY DRINK USE 67

drinking variables that have been shown to be highly reliable and consistent when compared to the 12-month Timeline Followback (TLFB; Roy, Dum, Sobell, Sobell, Simco, Manor et al., 2008), which is cited as the best known quantity-frequency measure for alcohol (Roy et al., 2008; Sobell, Agrawal, Sobell, Leo, Young, & Cunningham et al., 2003). The QDS produces highly reliable aggregate drinking data, yet takes only 3–5 mins to administer versus 20– 30 mins for the TLFB, making it more practical when multiple measures are used.

The original B-CEOA assesses drinkers’ risk taking and consequences of alcohol con- sumption. It contains a subset of 15 items that measure expectancies and valuations while using alcohol (Ham et al., 2005). To measure combined use, 12 additional ques- tions were added to the end of the original B-CEOA. The modified 27-item alcohol and combined use Comprehensive Effects of Combined-use measures provided a comparison of athletes’ expectancies while using alcohol only and when combining alcohol with en- ergy drinks. Participants indicated their expectancies for particular effects to happen to them while under the influence of alcohol and combined use on a scale ranging from 1 (disagree) to 4 (agree). Participants also indicated whether the effect would be good or bad on a second scale ranging from 1 (bad) to 4 (good). For more details see Ham et al. (2005).

RESULTS

Descriptive statistics from the QDS (N = 401) quantity/frequency measures indicated that a large percentage of athletes used both alcohol and energy drinks within the past year. From the QDS sample, 315 (78.6%) used alcohol, 150 (37.4%) combined alcohol with energy drinks, and 194 (48.4%) used energy drinks without alcohol. Of the 315 drinkers, 290 (92.1%) reported binge drinking in the past year, with binge drinking defined as “5 or more drinks on one occasion” (Sobell et al., 2003).

Results indicated combined users (n = 150) consumed significantly more alcohol and had riskier drinking habits (e.g., heavy binge drinking) than athletes who only used alcohol (n = 165). For example, athletes who only used alcohol reported an average of 9.80 alcoholic drinks (SD = 5.84) for the greatest number of drinks on one occasion compared to 18.35 alcoholic drinks (SD = 10.74) for combined users. Compared to athletes who only used alcohol, significant independent samples t-test results indicated combined users drank more often, consumed more alcohol per occasion, binge drank more often, drank considerably more alcohol on one occasion, and used more than double the amount of alcohol in the previous year. Table 1 summarizes the alcohol QDS results comparing athletes who only used alcohol to combined users.

Descriptive statistics of the combined-use sample used for the risk-taking and consequence analyses (n = 132) indicated that athletes consumed energy drinks more often and in greater amounts when using alcohol. When combining, 81 (61.36%) athletes consumed 3 or more energy drinks, which is identified as an “energy binge” and considered a high-risk drinking behavior (Woolsey, 2007). Without using alcohol, only 43 (32.58%) combined users consumed 3 or more energy drinks. The average number of “energy binge” episodes when using alcohol was 8.21 episodes (SD = 16.5) in the past year compared to 2.69 episodes (SD = 8.83) without alcohol. Therefore, athletes more frequently consumed potentially dangerous amounts of energy drinks in combination with alcohol.

Although combined users drank more alcohol than athletes who only used alcohol (n = 165), combined users reported drinking less alcohol when mixing alcohol and energy drinks. For example, when drinking alcohol only, combined users consumed an average of 8.60

68 C. WOOLSEY ET AL.

Table 1 Alcohol Quick Drink Screen Independent Samples t-test Results Comparing Athletes

Who Used Alcohol Only (n = 165) to Combined Users (n = 150) Alcohol Combined Independent

(n = 165) (n = 150) Samples t-test Alcohol Quick Drink Screen variables M SD M SD Mdif d T df sig.

Average days drinking per week

1.13 1.01 1.80 0.95 −0.67 .68 −6.05 313 .000∗∗

Average number of drinks per occasion

5.20 3.91 8.40 5.22 −3.20 .69 −6.20 313 .000∗∗

Total binge drinking episodes in past year

20.50 36.79 57.34 52.98 −36.84 .81 −7.16 307 .000∗∗

Greatest # of drinks on one occasion

9.80 5.84 18.35 10.74 −8.55 .99 −8.87 312 .000∗∗

Total # of drinks 369.9 508.0 887.6 794.5 −517.6 .78 −6.95 313 .000∗∗

∗∗p < .001.

alcoholic drinks (SD = 5.14) per occasion compared to 6.28 (SD = 4.41) when combining. Additionally, for the greatest number of alcoholic drinks on one occasion, combined users reported an average of 18.23 (SD = 10.56) compared to 10.83 (SD = 7.94) when combining. Table 2 summarizes the alcohol, combined use, and energy drink only QDS results.

The first hypothesis examined possible differences in reported risk-taking when athletes used alcohol-only compared to when they combined alcohol and energy drinks. The paired samples t-test results indicated that risk-taking was statistically significant, t(129) = −5.80, p = .001, with an effect size of −.40 and a mean difference of −2.05 suggesting a potential increase in risk-taking with combined use. The average mean score of the 10 risk-taking variables was 24.31 for alcohol (SD = 4.82, SE = .42), and 26.35 for combined use (SD =

Table 2 Quick Drink Screen Descriptive Statistics for Combined-Use Sample (n = 132) for Risk-

taking and Consequence Analyses

Quick Drink Screen variables N M SD

Alcohol - days drinking per week 132 1.76 .95 Combined-use - days drinking per week 132 0.85 .83 Energy drink only - days drinking per week 132 1.24 2.17

Alcohol - average # of drinks per episode 127 8.60 5.14 Combined-use - average # alcohol drinks per episode 123 6.28 4.41 Combined-use - average # energy drinks per episode 132 2.17 2.18 Energy drink only - average # drinks per episode 132 0.90 0.87

Alcohol - binge drinking episodes 130 54.89 50.85 Combined-use - alcohol binge drinking episodes 131 16.00 22.79 Combined-use - energy binge drinking episodes 131 8.21 16.50 Energy drink only - energy binge episodes 132 2.69 8.83

Alcohol - greatest # of drinks on one occasion 132 18.23 10.56 Combined-use - greatest # of alcohol drinks 132 10.83 7.94 Combined-use - greatest # of energy drinks 132 3.41 3.01 Energy drink only - greatest # on one occasion 132 2.10 3.11

RISKS OF ATHLETE ALCOHOL AND ENERGY DRINK USE 69

Table 3 Paired Samples t-test Results of Risk-taking Scale Variables (n = 131)

Alcohol Combined Paired Samples t-test

Variable (I would. . .) M SD M SD Mdif SD d t df Sig.

Enjoy sex more 2.69 1.03 2.61 1.09 .08 0.83 .07 1.06 130 .294 Be brave and daring 3.17 0.77 3.06 0.93 .11 0.91 .13 1.34 130 .183 Be courageous 3.00 0.77 3.02 0.90 −.02 0.85 .03 −0.31 130 .757 Act aggressively 2.46 0.95 2.76 1.12 −.30 0.93 .29 −3.68 130 .000∗∗ Take risks 3.18 0.72 3.21 0.81 −.03 0.76 .04 −0.46 130 .648 Be more alert 1.79 0.74 2.69 1.02 −.91 1.13 1.03 −9.18 130 .000∗∗ Feel stronger 2.25 1.01 2.66 1.09 −.41 1.04 .39 −4.55 130 .000∗∗ Sober up quicker 1.72 0.81 2.04 1.02 −.32 1.25 .35 −2.96 129 .004∗ Drive a motor vehicle 1.57 0.97 1.75 1.05 −.18 0.76 .18 −2.79 129 .006∗ Be more likely to fight 2.45 1.13 2.50 1.86 −.05 0.73 .04 −0.72 130 .475 ∗p < .01, ∗∗p < .001.

5.47, SE = .48), with a 95% confidence interval for the difference in the means of −2.42 for the lower and −1.04 for the upper bounds. Table 3 summarizes the results of the variables within the risk-taking scale.

The second hypothesis examined possible differences in reported negative consequences when athletes used alcohol-only compared to when they combined. The paired samples t- test results indicated negative consequences were statistically significant, t(129) = −6.782, p < .001, with an effect size of -.45 and a mean difference of −2.28 suggesting a potential for increased consequences with combined-use. The average mean score of the 10 negative consequence variables was 23.88 for alcohol (SD = 4.45, SE = .39), and 26.15 for combined- use (SD = 5.62, SE = .49), with a 95% confidence interval of −2.94 for the lower and −1.61 for the upper bounds. Table 4 summarizes the individual variables within the consequence scale.

Table 4 Paired Samples t-test Results of Consequence Scale Variables (n = 131)

Alcohol Combined Paired Samples t-test

Variable (I would. . .) M SD M SD Mdif SD d t df sig.

Feel dizzy 3.02 0.89 2.67 1.06 .34 1.01 .35 3.91 130 .000∗∗ Be clumsy 3.17 0.81 2.69 1.01 .47 0.92 .52 5.87 130 .000∗∗ Be loud, boisterous, or noisy 3.10 0.96 3.11 0.98 −.01 0.85 .01 −0.10 130 .919 Feel guilty 1.82 0.90 1.89 0.90 −.06 0.71 .07 −0.99 130 .327 Feel moody 2.17 0.98 2.22 0.96 −.05 0.81 .05 −0.65 129 .515 Not sleep well 1.87 0.98 2.71 1.15 −.84 1.25 .79 −7.72 130 .000∗∗ Be nervous or jittery 1.49 0.68 2.47 1.08 −.98 1.03 1.11 −10.82 130 .000∗∗ Get a hangover 2.75 0.96 2.76 1.04 −.01 0.99 .01 −0.09 130 .930 Experience a rapid heartbeat 1.85 0.85 2.90 1.06 −1.05 1.12 1.09 −10.67 130 .000∗∗ Be more likely to get injured 2.63 1.05 2.72 1.04 −.08 0.86 .08 −1.12 130 .266 ∗∗p < .001.

70 C. WOOLSEY ET AL.

DISCUSSION

The potential dangers for athletes using energy drinks are now greater than when Red Bull was the only drink on the market. Today, several energy drinks such as Cocaine (280 mg/8.4 oz) and SPIKE Shooter (300 mg/8.4 oz) contain caffeine levels approximately 3–4 times higher per ounce than a traditional 8.3 oz Red Bull at 80 mg (Woolsey, 2007). Perhaps more alarming is the rapid growth of energy shots containing 200+ mg of caffeine, with Redline Power Rush containing 350 mg in 2.5 ounces (Energyfiend, 2009). The general public also needs to be well-informed that energy drinks contain unregulated herbal stimulants. Stimulants such as yohimbine hydrochloride (HCL) and evodiamine are more powerful than caffeine and could be a greater danger to users than caffeine because most people do not have tolerances to these stimulants as they do to caffeine.

Energy drink advertising campaigns target adolescent and young adult populations who have been shown to be vulnerable to dependency and likely to become long-term users (Miller, 2008a; Miller & Carroll, 2006). Marijuana has long been termed as a “gateway drug” because it has been linked to the increased use of alcohol and other substances. Research has shown that stimulants found within energy drinks have similar effects on the brain and its neurotransmitters (e.g., dopamine, serotonin, nor-epinephrine) as other stimulant drugs of abuse (Miller & Carroll, 2006). Due to these implications and our survey findings, could energy drinks potentially be the next gateway drug? Given the health risks and dependency potential of energy drinks, parents, coaches, and health officials need to take measures to protect the public. A major concern is that energy drinks are not regulated by the Food and Drug Administration (FDA) and have not been recognized as safe. Furthermore, special precautions need to be implemented to protect adolescents because their brains are still developing, and they are often at lower bodyweights exposing them to higher stimulant doses per pound.

Results of this study reiterate the continuing problem of risky drinking habits among college athletes. There are effective alcohol interventions available such as the Brief Alcohol Screening and Intervention for College Students BASICS (Dimeff, Baei, Kivlahan, & Marlatt, 1999). The results of this study, however, suggest a need for modifications and the development of new energy drink and combined-use prevention and intervention programs. Within a group that has been identified as having increased problems from alcohol use, athletes could experience even greater problems from combining alcohol and energy drinks. Energy drinks have already been linked to increased alcohol consumption, health problems, risk-taking, and negative consequences (Miller, 2008a; Miller, 2008b; O’Brien et al., 2008; Woolsey, 2007). Given the potential gateway effects of energy drinks on the increased use of other stimulants, it is critical we continue to study energy drink use. It is time for change, and this change needs to start with parents, coaches, sport psychologists, and communities working together to protect our youth and the future health of athletes.

Many athletes come to sport psychologists with problems (known and un-known) related to alcohol and energy drink use such as anxiety and depression. Athletes may not realize the major effects that alcohol and energy drinks can have on brain chemistry and functioning. Both of these substances affect motivation, concentration, mood, and can create or exacerbate mental problems. With the widespread use of energy drinks in sport, it is important to understand athletes’ energy drink use and to examine the potential negative effects on mental/physical health and performance.

REFERENCES

Dimeff, L. A., Baei, J. S., Kivlahan, D. R., & Marlatt, G. A. (1999). Brief alcohol screening and intervention for college students: A harm reduction approach. New York: Guilford Press.

RISKS OF ATHLETE ALCOHOL AND ENERGY DRINK USE 71

Energyfiend. (2009). Caffeine in drinks. Retrieved on May 14, 2009, from http://www.energyfiend. com/huge-caffeine-database/.

Ferreira, S. E., Mello, M. T., Pompeia, S., & Souza-Formigoni, M. L. O. (2006). Effects of energy drink ingestion of alcohol intoxication. Alcoholism: Clinical and Experimental Research, 30, 598–604.

Food and Drug Administration. (2003). Substances generally recognized as safe. Code of Fed- eral Regulations. Title 21, Vol. 3 Sec. 182.1180, (2003). Retrieved December 20, 2008, from http://www.cfsan.fda.gov/∼lrd/fcf182.html.

Ford, J. (2007). Alcohol use among college students: A comparison of athletes and nonathletes. Substance Use & Misuse, 42, 1367–1377.

Ham, L. S., Stewart, S. H., Norton, P. J., & Hope, D. A. (2005). Psychometric assessment of the comprehensive effects of alcohol questionnaire: Comparing a brief version to the original full scale. Journal of Psychopathology and Behavioral Assessment, 27, 141–158.

Iyadurai, S. J., & Chung, S. S. (2007). New-onset seizures in adults: Possible association with consumption of popular energy drinks. Epilepsy Behavior, 10, 504–508.

Kapner, D. A. (2004). Ephedra and energy drinks on college campuses. The Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention. Retrieved December 8, 2008, from http://www.higheredcenter.org/files/product/energy-drinks.pdf.

Leichliter, J. S., Meilman, P. W., Presley, C. A., & Cashin, J. R. (1998). Alcohol use and related consequences among students with varying levels of involvement in college athletics. Journal of American College Health, 46, 257–262.

Malinauskas, B. M., Aeby, V. G., Overton, R. F., Carpenter-Aeby, T., & Barber-Heidal, K. (2007). A survey of energy drink consumption patterns among college students. Nutrition Journal, 6, 35. doi:10.1186/1475-2891-6-35.

Miller, K. (2008a). Frequent consumption of ‘energy-drinks’ linked with risky behavior. Alcoholism and Drug Abuse Weekly, 20, 7.

Miller, K. (2008b). Energy drinks, race, and problem behaviors among college students. Journal of Adolescent Health, 43, 490–497.

Miller, W. R., & Carroll, K. M. (2006). Rethinking substance abuse: What the science shows, and what we should do about it. New York: Guilford Press.

Nelson, T., & Wechsler, H. (2001). Alcohol and college athletes. Medicine and Science in Sports and Exercise, 33, 43–47.

O’ Brien, M., McCoy, T., Rhodes, S., Wagoner, A., & Wolfson, M. (2008). Caffeinated cocktails: Energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Academy for Emergency Medicine, 15, 451–460.

Red Bull GmbH. (2008). Company History. Retrieved on November 15, 2008, from http://www. fundinguniverse.com/company-histories/Red-Bull-GmbH-Company-History.html.

Reissig, C. J., Strain, E. C., & Griffiths, R. R. (2009). Caffeinated energy drinks: A growing problem. Drug and Alcohol Dependence, 99, 1–10. doi:10.1016/j.drugalcdep.2008.08.001

Roy, M., Dum, M., Sobell, L. C., Sobell, M. B., Simco, E. R., Manor, H., et al. (2008). Comparison of the Quick Drinking Screen and the alcohol Timeline Followback with outpatient alcohol abusers. Substance Use and Misuse, 43, 2116–23.

Sobell, L. C., Agrawal, S., Sobell, M. B., Leo, G. I., Young, L. J., Cunningham, J. A., et al. (2003). Comparison of a Quick Drinking Screen with the Timeline Followback for individuals with alcohol problems. Journal of Studies on Alcohol, 64, 858–861.

Walsh, M., Marquardt, K., & Albertson, T. (2006). Adverse effects from ingestion of Redline energy drinks. Clinical Toxicology, 44, 642.

Wechsler, H., Davenport, A. E., Dowdall, G. W., Grossman, S. J., & Zanakos, S. I. (1997). Binge drinking, tobacco, and illicit drug use and involvement in college athletics. Journal of American College Health, 45, 195–200.

Woolsey, C. (2007). A study of NCAA Division I athletes on the use and effects of combining alcohol & en- ergy drinks. Doctoral dissertation, University of Missouri, Columbia. Retrieved September 15, 2007, from http://edt.missouri.edu/Summer2007/Dissertation/WoolseyC-071207-D7933/research.pdf

Worrall, B. B., Phillips, C. D., & Henderson, K. K. (2005). Herbal energy drinks, phenylpropanoid compounds, and cerebral vasculopathy. Neurology, 65, 1137–1138.

Copyright of Journal of Applied Sport Psychology is the property of Routledge and its content may not be

copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written

permission. However, users may print, download, or email articles for individual use.