What's the BUZZ? Caffeine vs. Alcohol

We all know that caffeine is a stimulant, and most of us have a daily dose to fight fatigue and pep us up. So why create caffeinated ALCOHOLIC drinks? Doesn't that seem counter intuitive to put a stimulant (caffeine) with a sedative (alcohol)? A recent interesting high quality study, Acute impact of caffeinated alcoholic beverages on cognition: A systematic review points out a few facts you might want to share with your favorite college student...

• Energy drinks combined with alcohol DO decrease fatigue and "PERCEPTION of intoxication"
• However, despite FEELING unimpaired, complex tasks such as driving definitely ARE impaired.
• Additionally, caffeinated alcoholic beverages INCREASE impulsivity- which can obviously lead to drinking too much (further decreasing judgment and increasing impulsive choices).
• Finally, with this cycle of feeling less buzz and drinking more, ALCOHOL ADDICTION may increase.

I find this study particularly interesting in light of the "pre-gaming" with Attention Deficit Disorder (ADD) meds and alcohol that has become increasingly common on college campuses. Same concept- the ADD med stimulant taken before drinking alcohol blunts the "buzz" response from alcohol...at least for the first few drinks. Unfortunately, these stimulants do not blunt the other effects of alcohol toxicity such as decreased gag reflex, poor muscle coordination, feeling off-balance, nausea, vomiting, and ultimately impaired breathing. So what happens is you feel "fine" till suddenly you are unpleasantly drunk, then you risk vomiting with impaired consciousness and/or gag reflex...allowing you to choke and aspirate your own vomit-which, by the way, can be lethal. Or worse, you feel "fine" and choose to drive because you have no idea that your judgment and motor skills are significantly decreased, leading to a wreck that hurts not only you but potentially others...because you are driving a one ton weapon. 

BOTTOM LINE: Combining caffeinated energy drinks (or ADD meds) with alcohol is a potentially very dangerous choice because you blunt the "buzz" of alcohol without decreasing the other negative effects of rising blood alcohol levels. Just say NO.

Pre-Gaming with ADD Meds...A Dangerous Party Plan

Binge drinking in college students is not exactly breaking news.  My patients repeatedly explain "if you can't handle five shots of vodka, you are pretty lame".  They toss back multiple shots, have beers, then top off with mixed drinks. Hit the replay button once or twice, and the weekend is over. On Monday morning, they head back to class, seeming none-the-worse for wear beyond a headache.  How is this possible? Especially for adolescents who are only STARTING to drink, how exactly can they tolerate this volume of alcohol?  I started asking...and heard the same answer, over and over. "Well, to be honest, I pre-game with my ADD meds". 

PRE-GAME? Yes. Young people have figured out that when they take a prescription stimulant right before going out to party, they can "hold" more liquor. The stimulant takes away the typical buzzed, relaxed sedation of the first few drinks. Many have told me they "feel absolutely nothing at all from the alcohol...till I reach a certain number of shots, then suddenly I go from sober to super buzzed, and then either puke or pass out."

At first this confused me...wasn't the POINT of their drinking to catch that buzz in order to feel more social or confident? It seems counterintuitive. But if the peer pressure now is not only to drink, but to show you are so comfortable with drinking that it doesn't affect you- then this plan makes total sense. Except that this plan is so very dangerous, which makes it terrifying instead.

Unfortunately, not "feeling" the effects of alcohol does not mean that the alcohol is less potent within your brain, liver, bloodstream or nerves. This practice makes it far too easy to reach ALCOHOL POISONING levels, because you have turned off all your body's warning signs. Short term, you can hit toxic levels of alcohol that make you stop breathing. Or enough to "just" pass out...but then throw up and choke on your vomit. Long term, you are taking the HOV lane to end-stage alcohol complications because although you may only drink on weekends, you are getting huge quantities in at one time. And socially, this practice is normalizing binge drinking, because everyone sees their friends routinely drinking numerous drinks without it seeming to affect them.

A recent Cochrane meta-analysis Social norms information for alcohol misuse in university and college students examined 70 studies, including nearly 45,000 students. The premise was that college students have an inflated misperception of how much their peers are drinking, and therefore educating them about the true social norms may reduce alcohol-related consumption and subsequent problems. Although there were some significant effects, the "substantive meaningful benefits" were not enough to recommend policy changes.

As a side note, many students are taking ADD meds they have borrowed or purchased from a friend, which is not only illegal but magnifies their medical risk.

Yes, binge drinking in college has been around for a very long time, and thankfully the majority give up this habit when they hit the real world- if they survive their risky behavior. Note that a standard screening question for alcohol abuse is "have you had more than 4 drinks in one day during the last year?" 

Wondering how many drinks it would take for YOU to get alcohol poisoning? Check out one of my favorite resources: Aware, Awake, Alive

BOTTOM LINE: Doctors, parents and teens ALL need to know the dangers of "pre-gaming" with ADD meds.