***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Previous research on alcohol mixed with energy drinks ( AmED ) suffers from measurement problems . Missing from the research literature are studies that assess caffeine-alcohol co-ingestion in natural drinking environments . METHODS This field study collected data in a U.S. college bar district from 328 r and omly selected patrons . Anonymous data were obtained from face-to-face interviews and self-administered surveys , and from breath tests . RESULTS Cola-caffeinated alcoholic beverage consumers left bars in a more highly intoxicated state than those who consumed alcohol only . There was no significant difference between the intoxication level of the AmED group and the cola-caffeinated alcoholic beverage group . Results from a multivariate regression model indicated that quantity of caffeinated alcoholic beverage consumption had a significant , positive association with bar patron intoxication after adjusting for potential confounders . CONCLUSIONS Findings indicate that caffeine may have a dose-dependent relationship with alcohol intoxication in the bar/nightclub setting . In addition , results revealed that cola-caffeinated alcoholic drinks may pose similar levels of risk to bar patrons as those associated with AmED beverage consumption . Product labeling requirements about alcohol risks may need to be extended not only to energy drinks , but to caffeinated soft drinks as well BACKGROUND There are popular reports on the combined use of alcohol and energy drinks ( such as Red Bull and similar beverages , which contain caffeine , taurine , carbohydrates , etc . ) to reduce the depressant effects of alcohol on central nervous system , but no controlled studies have been performed . The main purpose of this study was to verify the effects of alcohol , and alcohol combined with energy drink , on the performance of volunteers in a maximal effort test ( cycle ergometer ) and also on physiological indicators ( oxygen uptake , ventilatory threshold , respiratory exchange rate , heart rate , and blood pressure ) , biochemical variables ( glucose , lactate , insulin , cortisol , ACTH , dopamine , noradrenaline , and adrenaline ) , and blood alcohol levels . METHODS Fourteen healthy subjects completed a double-blind protocol made up of four sessions : control ( water ) , alcohol ( 1.0 g/kg ) , energy drink ( 3.57 ml/kg Red Bull ) , and alcohol + energy drink , each 1 week apart . The effort test began 60 min after drug or control ingestion , and the dependent variables were measured until 60 min after the test . RESULTS Heart rate at the ventilatory threshold was higher in the alcohol and alcohol + energy drink sessions in comparison with control and energy drink sessions . Although in comparison to the control session , the peak oxygen uptake was 5.0 % smaller after alcohol ingestion , 1.4 % smaller after energy drink , and 2.7 % smaller after the combined ingestion , no significant differences were detected . Lactate levels ( 30 min after drug ingestion , 30 and 60 min after the effort test ) and noradrenaline levels ( 30 min after the effort test ) were higher in the alcohol and alcohol + energy drink sessions compared with the control session . CONCLUSIONS The performance in the maximal effort test observed after alcohol + energy drink ingestion was similar to that observed after alcohol only . No significant differences between alcohol and alcohol + energy drink were detected in the physiological and biochemical parameters analyzed . Our findings suggest that energy drinks , at least in the tested doses , did not improve performance or reduce alterations induced by acute alcohol ingestion BACKGROUND Well-known reports suggest that the use of energy drinks might reduce the intensity of the depressant effects of alcohol . However , there is little scientific evidence to support this hypothesis . OBJECTIVE AND METHODS The present study aim ed at evaluating the effects of the simultaneous ingestion of an alcohol ( vodka(37.5%v/v ) ) and an energy drink ( Red Bull-3.57 mL/kg ) , compared with those presented after the ingestion of an alcohol or an energy drink alone .  Twenty-six young healthy volunteers were r and omly assigned to 2 groups that received 0.6 or 1.0 g/kg alcohol , respectively . They all completed 3 experimental sessions in r and om order , 7 days apart : alcohol alone , energy drink alone , or alcohol plus energy drink . We evaluated the volunteers '  breath alcohol concentration , subjective sensations of intoxication , objective effects on their motor coordination , and visual reaction time . RESULTS When compared with the ingestion of alcohol alone , the ingestion of alcohol plus energy drink significantly reduced subjects ' perception of headache , weakness , dry mouth , and impairment of motor coordination . However , the ingestion of the energy drink did not significantly reduce the deficits caused by alcohol on objective motor coordination and visual reaction time . The ingestion of the energy drink did not alter the breath alcohol concentration in either group . CONCLUSIONS Even though the subjective perceptions of some symptoms of alcohol intoxication were less intense after the combined ingestion of the alcohol plus energy drink , these effects were not detected in objective measures of motor coordination and visual reaction time , as well as on the breath alcohol concentration OBJECTIVES The consumption of alcohol mixed with energy drinks ( AmED ) is popular on college campuses in the United States . Limited research suggests that energy drink consumption lessens subjective intoxication in persons who also have consumed alcohol . This study examines the relationship between energy drink use , high-risk drinking behavior , and alcohol-related consequences . METHODS In Fall 2006 , a Web-based survey was conducted in a stratified r and om sample of 4,271 college students from 10 universities in North Carolina . RESULTS A total of 697 students ( 24 % of past 30-day drinkers ) reported consuming AmED  in the past 30 days . Students who were male , white , intramural athletes , fraternity or sorority members or pledges , and younger were significantly more likely to consume AmED . In multivariable analyses , consumption of AmED was associated with increased heavy episodic drinking ( 6.4 days vs. 3.4 days on average ; p < 0.001 ) and twice as many episodes of weekly drunkenness ( 1.4 days/week vs. 0.73 days/week ; p < 0.001 ) . Students who reported consuming AmED had significantly higher prevalence of alcohol-related consequences , including being taken advantage of sexually , taking advantage of another sexually , riding with an intoxicated driver , being physically hurt or injured , and requiring medical treatment ( p < 0.05 ) . The effect of consuming AmED on driving while intoxicated depended on a student 's reported typical alcohol consumption ( interaction p = 0.027 ) . CONCLUSIONS Almost one-quarter of college student current drinkers reported mixing alcohol with energy drinks . These students are at increased risk for alcohol-related consequences , even after adjusting for the amount of alcohol consumed . Further research is necessary to underst and this association and to develop targeted interventions to reduce risk AIM To assess event-level associations between  energy drink consumption , alcohol intoxication , and intention to drive a motor vehicle in patrons exiting bars at night . METHOD Alcohol field study . Data collected in a U.S. college bar district from 802 r and omly selected and self-selected patrons .  Anonymous interview and survey data were obtained as well as breath alcohol concentration ( BrAC ) readings . RESULTS Results from logistic regression models revealed that patrons who had consumed alcohol mixed with energy drinks were at a 3-fold increased risk of leaving a bar highly intoxicated ( BrAC > or = 0.08g/210L ) , as well as a 4-fold increased risk of intending to drive upon leaving the bar district , compared to other drinking patrons who did not consume alcoholic beverages mixed with energy drinks . DISCUSSION These event-level associations provide additional evidence that energy drink consumption by young adults at bars is a marker for elevated involvement in nighttime risk-taking behavior . Further field research is needed to develop sound regulatory policy on alcohol/energy drink sales practice s of on-premise establishments Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND There has been a dramatic rise in the consumption of alcohol mixed with energy drinks ( AmED ) in young people . AmED have been implicated in risky drinking practice s and greater accidents and injuries have been associated with their consumption . Despite the increased popularity of these beverages ( e.g. , Red Bull and vodka ) , there is little laboratory research examining how the effects of AmED differ from alcohol alone . This experiment was design ed to investigate if the consumption of AmED alters neurocognitive and subjective measures of intoxication compared with the consumption of alcohol alone . METHODS Participants ( n=56 ) attended 1 session where they were r and omly assigned to receive one of 4 doses ( 0.65 g/kg alcohol , 3.57 ml/kg energy drink , AmED , or a placebo beverage ) . Performance on a cued go/no-go task was used to measure the response of inhibitory and activational mechanisms of behavioral control following dose administration . Subjective ratings of stimulation , sedation , impairment , and level of intoxication were recorded . RESULTS Alcohol alone impaired both inhibitory and activational mechanisms of behavioral control , as evidence d by increased inhibitory failures and increased response times compared to baseline performance . Coadministration of the energy drink with alcohol counteracted some of the alcohol-induced impairment of response activation , but not response inhibition . For subjective effects , alcohol increased ratings of stimulation , feeling the drink , liking the drink , impairment , and level of intoxication , and alcohol decreased the rating of ability to drive . Coadministration of the energy drink with alcohol increased self-reported stimulation , but result ed in similar ratings of the other subjective effects as when alcohol was administered alone . CONCLUSIONS An energy drink appears to alter some of the objective and subjective impairing effects of alcohol , but not others . Thus , AmED may contribute to a high-risk scenario for the drinker . The mix of impaired behavioral inhibition and enhanced stimulation is a combination that may make AmED consumption riskier than alcohol consumption alone OBJECTIVE Studies have shown that expectations of alcohol-induced impairment can produce adaptive responses to alcohol that reduce the degree of behavioral impairment displayed . The present study tested psychomotor performance following combined caffeine and alcohol administration in 42 social drinkers ( 23 men ) . Subjects were led to expect either that caffeine would antagonize alcohol-induced impairment or that it would have no effect . The study tested the hypothesis that drinkers who expected an antagonist effect of caffeine would display greater alcohol impairment than those who expected no antagonist effect . METHOD Groups practice d a pursuit rotor task and received a moderate dose of alcohol ( 0.65 g/kg ) combined with either 4.0 mg/kg caffeine or placebo caffeine . Some groups were led to expect that caffeine would counteract the impairing effect of alcohol and others were led to expect no counteracting effect . Psychomotor performance was then tested over a 3-hour period . RESULTS In accord with the hypothesis , groups led to expect counteracting effects of caffeine displayed greater impairment than those led to expect no counteraction . Caffeine had no significant antagonist effect on alcohol impairment . CONCLUSIONS The findings suggest that compensation for alcohol impairment occurs when drinkers hold clear expectations that the drug will disrupt performance . When no such clear expectation exists , no compensatory response occurs and the impairing effects of alcohol are observed The consumption of alcohol mixed with energy drinks ( AmED ) has become a popular and controversial practice among young people . Increased rates of impaired driving and injuries have been associated with AmED consumption . The purpose of this study was to examine if the consumption of AmED alters cognitive processing and subjective measures of intoxication compared with the consumption of alcohol alone . Eighteen participants ( nine men and nine women ) attended four test sessions where they received one of four doses in r and om order ( 0.65 g/kg alcohol , 3.57 ml/kg energy drink , AmED , or a placebo beverage ) . Performance on a  psychological refractory period ( PRP ) task was used to measure dual-task information processing and performance on the Purdue pegboard task was used to measure simple and complex motor coordination following dose administration . In addition , various subjective measures of stimulation , sedation , impairment , and level of intoxication were recorded . The results indicated that alcohol slowed dual-task information processing and impaired simple and complex motor coordination . The coadministration of the energy drink with alcohol did not alter the alcohol-induced impairment on these objective measures . For subjective effects , alcohol increased various ratings indicative of feelings of intoxication . More importantly , coadministration of the energy drink with alcohol reduced perceptions of mental fatigue and enhanced feelings of stimulation compared to alcohol alone . In conclusion , AmED may contribute to a high-risk scenario for a drinker . The mix of behavioral impairment with reduced fatigue and enhanced stimulation may lead AmED consumers to erroneously perceive themselves as better able to function than is actually the case Summary . The effects of Red Bull Energy Drink , which includes taurine , glucuronolactone , and caffeine amongst the ingredients , were examined over 3 studies in a total of 36 volunteers . Assessment s included psychomotor performance ( reaction time , concentration , memory ) , subjective alertness and physical endurance . When compared with control drinks , Red Bull Energy Drink significantly ( P < 0.05 ) improved aerobic endurance ( maintaining 65–75 % max . heart rate ) and anaerobic performance ( maintaining max . speed ) on cycle ergometers . Significant improvements in mental performance included choice reaction time , concentration ( number cancellation ) and memory ( immediate recall ) , which reflected increased subjective alertness . These consistent and 
    Output:
    
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 .
Mixing 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