New research demonstrates a connection between the consumption of energy drinks and the use of alcohol and drugs among adolescents.

Energy drinks or shots promise increased energy, enhanced athletic performance, and even clearer thinking, so of course they’re attractive to some adolescents as they strive to excel in school sports, their studies, and extracurricular activities. And many parents believe that these drinks are mostly harmless—but they may want to think again.

In a recent study published in the Journal of Addiction Medicine, it was shown that consuming energy drinks was strongly and positively associated with alcohol, cigarette, and illicit drug use in the preceding 30 days by adolescents. The observed associations between energy drinks and substance use were significantly stronger than those between regular or diet soft drinks and substance use.

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The report suggests that personality traits that make a young person more likely to consume an energy drink—such as being a risk taker—may increase the chances that he or she will try addictive substances.

Researcher Yvonne M. Terry-McElrath and colleagues at the Institute of Social Research at the University of Michigan studied U.S. secondary school students in 2010 and 2011, looking at energy and soft-drink consumption and its associations with substance abuse. As part of the Monitoring the Future (MTF) study, surveys were administered to students in the 8th, 10th, and 12th grades.

Approximately 30 percent of student respondents reported consuming energy drinks or shots. The study also found that 8th graders reported a significantly higher frequency of consuming energy drinks than 10th or 12th grade students, and that the consumption frequency was significantly higher for adolescent boys than for adolescent girls. Consumption of both soda and energy drinks was highest among adolescents in families with low average parental education as well as in single-parent households.

Cautioning that this study does not establish causation between the behaviors, the researchers recommend education for parents and prevention efforts among young people. This includes information on the masking effects that the caffeine in energy drinks can have on alcohol- and other substance-related impairments, and recognition that some groups may be particularly likely to consume energy drinks and to be substance users.

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Energy drinks generally contain extra-large doses of caffeine and/or other legal stimulants. An energy drink may contain between 75 milligrams to more than 200 milligrams of caffeine per serving—compared with the 34 milligrams in a Coke. Some energy drinks list additives such as guarana, which can contain about four times the amount of caffeine that coffee beans have; however, many consumers don’t recognize this ingredient as a source of caffeine.

Commenting on the study’s findings, Janet P. Engle, PharmD, FAPhA, head of the Department of Pharmacy Practice at the University of Illinois at Chicago (who was not involved in the study), advised, “Everyone wants the magic bullet for getting energized and staying awake. However, energy drinks are not the best answer. There is a lack of research and regulation associated with energy drinks, and they may cause dangerous health consequences in users.”

“Energy drinks are characterized as nutritional supplements, so they avoid the limit of 71 milligrams of caffeine per 12 ounces that the FDA has set for soda,” she added. “In Germany, health officials have been tracking the health effects of energy drinks since 2002. Some of the adverse effects reported include liver damage, seizures, respiratory disorders, agitation, confusion, psychotic conditions, cardiac effects and death.”

Engle adds that because energy drinks are considered nutritional supplements, they are required to list only recommended dietary information for nutrients. Since caffeine is not considered a nutrient, it doesn’t have to be listed—so it can be very difficult for consumers to determine how much caffeine they’re ingesting.

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