Robert (name changed) rubs the bump on his head. That was not there the night before. He struggles to remember what happened last night; it remains a blur. He recalls the porcelain toilet he hugged at 4 a.m. He remembers guzzling a can of Four Loko before partying.
Robert’s story is not uncommon. Alcoholic energy drinks have become a popular drink of choice among young adults, and a study reported in the Nutrition Journal found that 51 percent of college students consumed more than one energy drink in the average month, and of these energy drink users, 54 percent consumed alcohol mixed with energy drinks.
Known as a blackout in a can, alcoholic beverages with caffeine additives feature fruity flavors, a low price and a source of alcohol poisoning. The mixture of alcohol with energy drinks increases the risks of intoxication three-fold, according to a survey published by the American Journal of Preventive.
“I’ve had a fair share of Four Lokos, after one or even half of one, you start to go into a phase where you don’t know what’s going on,” said Robert, a recent graduate now in college. “It really is a blackout in a can. The next thing I know, I’m passed out somewhere.”
Watchdog agencies and state leaders called for federal regulation of these beverages in October and November, citing the mixture of alcohol and caffeine as a recipe for disaster. Lisa Stone, a health educator at the University of Richmond warns that a single 23.5 ounce can contain the alcohol content equivalent of up to six beers depending on body mass, and the caffeine content equivalent of one to one and a half cups of coffee.
“The purpose of the stimulants, such as caffeine, is to speed up the effect of alcohol and it masks the effect,” Lisa Stone said. “(Young adults) don’t realize how drunk they are getting. They run a risk of alcohol poisoning, increased impairment, increased chance of drunk driving (and) increased chance of unwanted sexual and violent actions.”
Those who consume alcohol with energy drinks are about twice as likely as those who do not mix alcohol with energy drinks to report being taken advantage of sexually, to report taking advantage of someone else sexually and to report riding with a driver who was under the influence of alcohol, according to a Wake Forest University study.
“It’s a risky behavior choice,” Stone said. “The sole purpose is to get drunk quickly.”
Along with behavioral consequences, those who consume alcohol mixed with energy drinks are three times more likely to binge drink than those who do not report mixing alcohol with energy drinks, according to a University of Florida study based on blood alcohol concentrations.
“It is easy to get carried away when drinking them because it doesn’t taste like you are consuming that much alcohol,” said one student who first tried an alcohol energy drink last year at a party. “I think that these drinks are riskier because of the amount that can be consumed so quickly.”
Joose, Four Loko and Moonshot are among the 25 brands of caffeinated alcoholic beverages sold in retail alcohol outlets, including convenience stores, according to the Center for Disease Control and Prevention.
Joose, Max, Four Loko and Core High Gravity all come in 23.5-ounce cans and sell between $2 and $5. Each typically contains the alcohol content equivalent to four regular or five light beers, according to the Federal Trade Commission. Depending on state regulations, Four Loko cans contain six percent or 12 percent alcohol.
“It beats buying $25 worth of liquor or a case of beer, because two cans has the same effect as all that stuff for about $5,” Robert said.
Experts claim that colorful packaging and flavors target a younger market, especially teens. Four Loko comes in eight flavors: orange, fruit punch, lemonade, cranberry lemonade, grape, watermelon, blue raspberry and lemon-lime.
“I do not agree with the packaging, price point and marketing that is directed toward an underage population,” said Amber Bodner, Community Coordinator for the Dare Coalition Against Substance Abuse. “I also feel that these products are equally dangerous to those 21 and over due to the combination of caffeine and alcohol and that many of these drinks contain the equivalent of five or more drinks in one can and many consumers may not be aware of how much they are actually drinking.”
What concerns Stone, Bodner and other health educators is that these beverages contain stimulants, which makes drinkers more alert and energetic. Alcohol is a depressant, which slows the function of the central nervous system, according to TeensHealth. The Journal Review states that alcohol mixed with caffeine is a dangerous concoction because people typically experience a reduction of the sensations typically associated with alcohol, believed to be a result of caffeine counteracting the depressive effects and keeping the individual more alert.
“Research shows evidence that consumers of alcohol energy drinks also drink larger quantities of alcohol; that caffeine may mask the negative effects of alcohol intoxication, producing skewed self-impressions of impairment levels and the drinks may produce the ‘wide awake and drunk’ phenomenon that increases the likelihood of injury and/or violence to oneself and others,” Bodner said.
Live Strong reports that healthcare providers recommend that people consume no more than 100 mg of caffeine daily. A 23.5-ounce can of Four Loko exceeds the daily recommended dose, containing 156 mg of caffeine, or about the same amount of caffeine in a tall Starbucks coffee, according to Phusion Projects, the makers of Four Loko.
“Your body is still awake because of the caffeine and it’s an improper balance,” Robert said. “When you’re drunk, you just want to pass out and sleep it off.”
Caffeinated alcoholic beverages made headlines in October when nine Central Washington University students were hospitalized after engaging in underaged drinking at an off-campus party. Blood-alcohol concentrations of the students ranged from 0.12 to 0.35 percent, according to MSNBC. Any BAC above 0.08 is considered legally intoxicated and scientists consider any BAC above 0.35 to be potentially lethal, the University of Texas at Austin reports.
Police officers found cans of Four Loko and hard-liquor bottles at the scene and believe students mixed the caffeinated alcoholic beverages with vodka and rum. The party made national headlines and educators called for a ban on these products. The university banned Four Lokos from its campus.
“The unacceptable incident at Central Washington University, which appears to have involved hard liquor, such as vodka and rum, beer, our products, and possibly illicit substances, is precisely why we go to great lengths to ensure our products are not sold to underage consumers and are not abused,” Phusion Projects said in a statement.
Although Phusion Projects claims on its website that caffeine and alcohol have been mixed together safely for years and provides materials for college advisers to use in effort to prevent underage consumption, experts believe caffeinated alcoholic beverages are largely consumed by young adults and pose serious health risks for inexperienced drinkers.
“The energy drink market is geared toward high school and college students. These beverages are clearly marketed toward teens and young adults,” Stone said. “Alcohol is a drug that can be safe in moderation, which is one to two drinks for an adult. But these cans are equivalent to six drinks; in that case, (people) are drinking for impairment. It certainly poses a risk for underage drinking.”
Over the years, the energy drink market has exploded, to the dismay of health educators like Stone. Report Buyer estimates that the energy drink market will surpass $9 billion in sales. The CDC reports that energy drinks are regularly consumed by 31 percent of 12- to 17-year-olds and 34 percent of 18- to 24-year-olds.
Two leading manufacturers of alcoholic energy drinks saw their sales increase by 67 times between 2002 and 2008, according to the CDC. Robert said he has noticed the drinks gain popularity after seeing one for the first time in 2009 at a party.
“I’ve seen it a lot at tailgate parties because it looks like fruit punch and like no one is drinking,” Robert said. “I think it won’t become the major drink of choice, but it will still have a good percentage that drink it because it’s a quick way to get drunk and it’s cheap.”
As energy drink sales increase, alcohol-related deaths remain one of the leading causes of preventable deaths. Excessive alcohol consumption is responsible for over 79,000 deaths and 2.3 million years of potential life lost in the United States each year, according to the CDC.
The Central Washington University incident is not the first time alcoholic energy drinks made headlines. In 2007, Anheuser-Busch agreed to pull the 12 percent alcohol beverage called Spykes after a public outcry from alcohol watchdog organizations and politicians, according to CNN.
In 2008, the Center for Science in the Public Interest sued MillerCoors Brewing Company accusing that its alcoholic energy drink, Spark, appealed to underage drinkers by suggesting the alcoholic drink was similar to soda, according to CNN. The company agreed to reformulate its ingredients.
In November 2009, the U.S. Food and Drug Administration notified about 30 manufacturers of alcoholic energy drinks that it intended to investigate for safety and determine if it is lawful to add caffeine to alcohol. Substances added to food are illegal unless approved by the FDA beforehand, under the Federal Food, Drug and Cosmetic Act.
“The marketing, packaging and price point of these beverages have made them a popular item for those underage and college students – most of which are underage as well – one of the many reasons the FDA and Attorney General’s Office has these products under review,” Bodner said.
While the FDA began questioning the safety of these beverages, bans have only recently surfaced. After the Central Washington University incident, Washington State Attorney General Rob McKenna called for a ban of caffeinated alcoholic beverages in the state, according to a press release.
“It’s time to bring an end to the sale of alcoholic energy drinks,” McKenna said in the press release. “They’re marketed to kids by using fruit flavors that mask the taste of alcohol and they have such high levels of stimulants that people have no idea how inebriated they really are. They’re packaged just like non-alcoholic drinks but include a dangerous dose of malt liquor.”
Following suit, Michigan Liquor Control Commission decided to ban the sale of all alcoholic energy drinks in the state, citing safety concerns and health risks as the reason. Michigan is among the first states, including California, Montana, Washington and Utah, to place short-term bans on alcoholic energy drinks, according to WRAL.
On Nov. 12, North Carolina Gov. Beverly Perdue, called for manufacturers to voluntarily withdraw malt beverages containing stimulants from the North Carolina market until they are found to be safe and reviewed by the FDA, according to WRAL.
“Teenagers and college students are drinking these drinks and ending up in the hospital,” Perdue said in a statement to WRAL. “The time to act on this is now, before we are faced with the death of one of our young people. The only responsible way to allow these drinks on our shelves is to first carefully review their health effects.”
Phusion Projects said in a statement on Nov. 16 that it would remove the stimulants caffeine, guarana and taurine from its products nationally.
“We are confident that we will continue to grow our brands and remain innovative,” Chris Hunter, a co-founder of Phusion Projects, said in a Wall Street Journal interview.
The following day, Nov. 17, the FDA and FTC issued warning letters to four manufacturers of alcohol energy drinks: Phusion Projects LLC., makers of Four Lokos; United Brands Co., makers of Joose and Max; Charge Beverages Corp, makers of Core High Gravity; and New Century Brewing Co., makers Moonshot. The FDA said the drinks are an unsafe food additive and that further action, including seizure of their products would be possible if they continued to produce the drinks.
North Carolina has also taken action. On Nov. 18, the North Carolina alcohol commission announced that it would allow stores that no longer want to stock alcoholic energy drinks to get a refund from their suppliers.
“It’s in the best interest for people to ban these drinks,” Robert said. “People that go to parties to get messed up beyond repair have two Four Lokos and you find them later in a bush passed out. I wouldn’t drink them again, they’re nasty anyways.”
Some disagree with the ban, citing that underage drinking was a problem before the manufacture of alcoholic energy drinks.
“I think they carry the same risk as beer, it’s all alcohol and impairs you the same way,” one student said.
Campaigning for years, Dare CASA aims to bring awareness to risks associated with alcohol energy drinks and underage consumption.
In 2007, underaged drinking cost North Carolina $1.4 billion, according to the Pacific Institute for Research and Evaluation. Dare CASA hopes to lower the cost and effects of underage drinking in the Outer Banks community.
“CASA promotes the health and safety of our community including the health and safety of our teenagers. As an organization we work to prevent underage drinking as alcohol kills more kids than all illegal drugs combined,” Bodner said. “A person’s brain does not stop developing until his or her early to mid 20s. The brain goes through dynamic change during adolescence, and alcohol can seriously damage long- and short-term growth processes.”
People who consume energy drinks frequently, 52 or more times a year, have a much higher risk of binge drinking and becoming alcohol dependent, a study from the University of Maryland suggests. Stone believes alcoholism is a growing concern among young people and that alcoholic energy drinks contribute to the problem, as they appeal to young adults. The National Institute on Alcohol Abuse and Alcoholism also suggests that alcoholism is becoming a problem, as 53 percent of the nation’s alcoholics were identified as young people, pre-teen to age 26, in 2007.
“Through our coalition work and partnerships with other community coalitions; we have seen the issue and resulting problems from alcohol energy drinks across the state of North Carolina, as well as across the nation,” Bodner said.
Dare CASA applauded the news of the FDA’s and North Carolina alcohol commission’s actions in a press release because it contributes to the success of organizations like itself and aids in combating underage drinking and alcohol abuse.
“What has just occurred demonstrates what can happen when enough adults mobilize and relentlessly request action. This is a victory for all of the grassroots initiatives like Dare CASA who have been educating the public for several years and demanding policy changes relative to alcohol energy drink,” said Tim Hill, Executive Director for Dare CASA in the press release. “In addition it is another important wake-up call about the products that are being marketed to teens and young adults. We should all be proud of what has just occurred.”
While the federal and state actions will bring awareness to the dangers of alcohol energy drinks and other problems, such as excessive alcohol consumption and underaged drinking, Dare CASA will not end its efforts and continue to advocate for community, state and national measures for further prevention.
“Death and serious overdose incidents have been reported all too often among high school and college students due to alcohol energy drinks,” Bodner said. “Sadly, many parents and adults are unaware of these products. We feel it is important to also educate parents as well as students about the serious concerns surrounding these products.”