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Despite the political and health imperative, there has been no systematic and independent synthesis of the literature to determine whether or not <jats:styled-content style=\"fixed-case\">AmED<\/jats:styled-content> offers additional harms relative to alcohol. The aim of this study was to review the evidence about whether co\u2010consumption of energy drinks and alcohol, relative to alcohol alone, alters: (i) physiological, psychological, cognitive and psychomotor outcomes; (ii) hazardous drinking practices; and (iii) risk\u2010taking behaviour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pubmed, PsycInfo and Embase databases were searched until <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>ay 2013 for papers outlining descriptive, observational analytical and human experimental studies which compared target outcomes for <jats:styled-content style=\"fixed-case\">AmED<\/jats:styled-content> versus alcohol consumers (between\u2010subjects), or <jats:styled-content style=\"fixed-case\">AmED<\/jats:styled-content> versus alcohol consumption (within\u2010subjects). Odds ratios were calculated for target outcomes following screening, data extraction and quality assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data were extracted from 19 papers. Analyses typically revealed increased odds of self\u2010reported stimulation\u2010based outcomes and decreased odds of sedation\u2010based physiological and psychological outcomes relative to when alcohol was consumed alone, as indicated by rigorous cross\u2010sectional descriptive research. These findings typically have not been reflected in experimental research, due possibly to the low doses administered relative to typical self\u2010reported \u2018real\u2010life\u2019 intake. <jats:styled-content style=\"fixed-case\">AmED<\/jats:styled-content> consumers generally report more hazardous alcohol consumption patterns and greater engagement in risk\u2010taking behaviour than alcohol consumers. While most studies had equivocal findings, two studies showed lower odds of risk\u2010taking behaviour for <jats:styled-content style=\"fixed-case\">AmED<\/jats:styled-content> relative to alcohol drinking sessions but limitations with respect to the outcome measures used restrict conclusions with regard to the behavioural outcomes of <jats:styled-content style=\"fixed-case\">AmED<\/jats:styled-content> use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Mixing alcohol with energy drinks may exert a dual effect, increasing stimulation\u2010based effects and reducing sedation\u2010based 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\u2010taking behaviour.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.12622","type":"journal-article","created":{"date-parts":[[2014,5,20]],"date-time":"2014-05-20T12:25:32Z","timestamp":1400588732000},"page":"1612-1633","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["\u2018High\u2019 risk? A systematic review of the acute outcomes of mixing alcohol with energy drinks"],"prefix":"10.1111","volume":"109","author":[{"given":"Amy","family":"Peacock","sequence":"first","affiliation":[{"name":"School of Psychology University of Tasmania  Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Pennay","sequence":"additional","affiliation":[{"name":"Centre for Alcohol Policy Research Turning Point Eastern Health  Melbourne Victoria Australia"},{"name":"Centre for Health and Society School of Population and Global Health University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Droste","sequence":"additional","affiliation":[{"name":"School of Psychology Deakin University  Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimondo","family":"Bruno","sequence":"additional","affiliation":[{"name":"School of Psychology University of Tasmania  Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan I.","family":"Lubman","sequence":"additional","affiliation":[{"name":"Turning Point Eastern Health  Melbourne Victoria Australia"},{"name":"Eastern Health Clinical School Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,7,14]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"104","article-title":"Combining energy drinks and alcohol: a recipe for trouble","volume":"40","author":"Pennay A.","year":"2011","journal-title":"Aust Fam Physician"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2011.07.003"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2007.00464.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00085.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2006.00070.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2011.01464.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.109"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S29313"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2010.04.090261"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3810\/psm.2010.04.1768"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1542\/pir.34-2-55"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.3810\/psm.2010.06.1796"},{"key":"e_1_2_7_14_1","first-page":"25","article-title":"Energy drinks: psychological effects and impact on well\u2010being and quality of life\u2014a literature review","volume":"9","author":"Ishak W.","year":"2012","journal-title":"Innov Clin Neurosci"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2010.03.015"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2008.08.001"},{"key":"e_1_2_7_17_1","unstructured":"Australian Medical Association.Alcohol and energy drinks: a toxic mix. 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