Risks of alcohol–energy drink co‐consumption: Patterns, correlates and psychological outcomes in youth

BACKGROUND AND OBJECTIVES: This study examined the prevalence of alcohol mixed with energy drinks (AmED) among Spanish adolescents and young adults and analyzed its associations with sociodemographic factors, substance use, and mental health. The primary objective was to compare AmED users specifically against alcohol-only users to identify unique risk profiles. METHODS: A cross-sectional survey was administered to 6156 individuals aged 16-30 enrolled in educational programs. Participants completed self-report measures assessing substance use, emotional distress, schizotypal traits, and suicidal behavior. Bivariate analyses compared AmED users with alcohol-only users and non-drinkers. Logistic regression identified independent correlates of AmED use specifically within the alcohol-using population. RESULTS: Among alcohol users, 31.3% reported consuming AmED. AmED users were more likely to be younger and male, and they initiated alcohol use earlier. They showed a higher prevalence of tobacco, e-cigarette, and cannabis use, as well as a greater risk of problematic alcohol, nicotine, and cannabis consumption. AmED users also reported elevated emotional distress, suicide behavior, and the schizotypal traits dimensions of anhedonia and interpersonal disorganization. Logistic regression identified younger age, male sex, binge drinking, e-cigarette use, nicotine dependence, alcohol-related problems, cannabis abuse risk, suicidal behavior, and schizotypal traits as significant correlates of AmED use. DISCUSSION AND CONCLUSIONS: AmED consumption is common among Spanish youth and is more strongly linked to polysubstance use and poor mental health than alcohol use alone. SCIENTIFIC SIGNIFICANCE: Screening for AmED use may help identify youth at higher risk of polysubstance use and suicidal behavior, facilitating earlier detection and targeted prevention efforts.