Alcohol mixed with energy drinks and aggressive behaviors in adolescents and young adults: A systematic review

Purpose: Consuming alcohol mixed with energy drinks (AmED) is a high-risk drinking practice. This systematic review examines how AmED use contributes to aggression (physical and sexual), in what role(s) (perpetrator and/or victim), in adolescents and young adult drinkers (age 25 and younger). Methods: Computer assisted search identified 844 studies conducted prior to March 2023; of them 17 met inclusion criteria. Results: AmED use was significantly associated with aggressive behaviors. Between-subject studies suggests that AmED consumers have higher rates of perpetration (physical fights, bullying) and victimization compared to peers who only drink alcohol; however, within-subject studies of AmED users find no difference in physical aggression by drinking event (AmED vs. occasions where consumer drinks alcohol only). Similarly, AmED use was a risk factor for sexually aggressive behaviors (e.g., unwanted contact) and victimization. Conclusions: AmED use is a significant risk factor both victimization and perpetration of violent acts. Differences in within- versus between-study findings suggests that risk is associated with use of AmED, and not event level differences in drinking occasions among AmED users. Findings highlight the relative paucity of studies examining victimization and sexual violence and the need for future studies to incorporate more diverse samples and methodologies to better understand patterns of AmED use, perpetration, and victimization.