BACKGROUND Whilst energy drinks improve performance and feelings of alertness, recent articles suggest that energy drink consumption combined with alcohol may reduce perception of alcohol intoxication, or lead to increased alcohol or drug use. This review discusses the available scientific evidence on the effects of mixing energy drinks with alcohol. METHODS A literature search was performed using the keywords "energy drink and Red Bull(®)" and consulting Medline/Pubmed, PsycINFO, and Embase. RESULTS There is little evidence that energy drinks antagonize the behavioral effects of alcohol, and there is no consistent evidence that energy drinks alter the perceived level of intoxication of people who mix energy drinks with alcohol. No clinically relevant cardiovascular or other adverse effects have been reported for healthy subjects combining energy drinks with alcohol, although there are no long-term investigations currently available. Finally, whilst several surveys have shown associations, there is no direct evidence that coadministration of energy drinks increases alcohol consumption, or initiates drug and alcohol dependence or abuse. CONCLUSIONS Although some reports suggest that energy drinks lead to reduced awareness of intoxication and increased alcohol consumption, a review of the available literature shows that these views are not supported by direct or reliable scientific evidence. A personality with higher levels of risk-taking behavior may be the primary reason for increased alcohol and drug abuse per se. The coconsumption of energy drinks being one of the many expressions of that type of lifestyle and personality.