Four Loko May Be Gone, but Dangerous Alcohol Drinks Remain

Sugary high-alcohol drinks make dangerous drinking easy for teens.

Two cans of the 23.5 ounce 'Four Loko' malt liquor energy drink are seen in this November 14, 2010 photo in Washington, DC. Four Loko, which has an alcohol content of 12 percent and as much caffeine as a cup of coffee, came under scrutiny this fall after students who drank it at Central Washington University in Ellensburg, Washington, and Ramapo College in New Jersey ended up in emergency rooms, some with high levels of alcohol poisoning. Earlier this month, both Washington State and Michigan banned the sale of energy drinks that contain alcohol and caffeine. Officials in New York on Sunday announced that Phusion Products, the Chicago company that makes the beverage, agreed to stop shipments to that state by November 19.

Caffeine and alcohol don't mix well, which is why the Food and Drug Administration has ordered the manufacturers of Four Loko, Core High Gravity, Moonshot, Joose, and Max to stop selling the amped-up drinks. According to the FDA, caffeine is an "unsafe food additive"—at least when it's mixed with a potent slug of alcohol.

The FDA's ban on caffeinated alcohol has been a long time brewing, but an incident in October, when nine students at Central Washington University ended up at the hospital after drinking Four Loko, might have pushed the FDA to act. The drink had 12 percent alcohol in each 23.5-ounce can; by the ounce, that's three times the amount as in a typical beer, and the alcohol equivalent of four glasses of wine. The drink comes in flavors like lemonade and watermelon. So it's no wonder that someone could down several and find himself in serious trouble.

"We're seeing a disturbing trend, in which marketers are targeting these younger drinkers," says Daniel Z. Lieberman, professor of psychiatry and behavioral sciences at George Washington University, in Washington, D.C. "They're doing it with high sugar content. They're doing it with flavors that appeal to young drinkers—fruit punch, raspberry, peach—and they're doing it by making [the drinks] inexpensive."

This isn't the first time that a drink that seems designed for binge drinking has been marketed to young people. The alcohol industry has a long and ignoble history of marketing soda pop-like alcohol drinks that appeal to teens and tweens because they mask the taste of alcohol. Adding caffeine is just the latest wrinkle, inspired by the huge success of Red Bull and other caffeine-laden energy drinks.

Unfortunately, adding caffeine to alcohol doesn't cancel out the ill effects of drinking too much: A caffeinated drunk is just as stupid, and arguably more dangerous, as a drowsy drunk. Students who drank caffeine with alcohol could still react quickly, but they made just as many errors as regular drunks, according to a study from the University of Kentucky. Researchers at Wake Forest University in Winston-Salem, N.C., found that students who mixed caffeine and alcohol were more likely to get injured, get in a car with a drunk driver, or be involved in nonconsensual sex.

[Driving Drowsy as Bad as Driving Drunk]

The campaign against caffeinated alcohol was launched in 2007 by state attorneys general, who are in charge of enforcing state alcohol laws. "We're really concerned about all these products," Jessica Maurer, special assistant to Steve Rowe, Maine's attorney general, told me then. "We think they are potentially dangerous, particularly at a time when every state is seeing incredible binge drinking rates among our youth. Products that promise the ability to keep you up all night so you can party longer [send] absolutely the wrong message."

As a result of the campaign by the attorneys general of Maine and 18 other states, Miller and Anheuser-Busch removed caffeine from Sparks and Tilt, two caffeinated beers, in 2008 and agreed not to market other caffeinated alcoholic drinks.

Last year, the FDA warned manufacturers of almost 30 caffeinated alcoholic drinks that it was investigating the safety of caffeine-alcohol blends. That list was winnowed to the four manufacturers cited last week. That's because the drinks the FDA chose to go after are marketed more like soft drinks than like liquor. It's hard to imagine someone considering "Booya Espresso Silver Tequila with Caffeine" (one of the drinks in the original petition) as an easy quaff.

Parents and teenagers should be wary not just of Four Loko and its buzzy cousins, but any alcoholic drink that masquerades as a soft drink. Read emergency room doctor Barbara Lock's blog about what it's like to try to save the lives of dangerously drunk teenagers, who are brought in unconscious as the result of too much "fun" with drinks like Four Loko. "Stay away from alcoholized energy drinks in giant cans," Lock warns, saying that if the size of the container was adjusted to reflect the amount of alcohol in a beer or a glass of wine, Four Loko would come in 5-ounce cans.

The problems with Four Loko and its ilk make a great opening for parents to talk with kids about the importance of resisting pressure to drink. "We know with a great deal of certainty that when parents talk to their kids about drugs and alcohol kids gain a level of protection," Lieberman says. "Parents are reluctant to do it because they think the kids will just roll their eyes. But we know that kids hear the message."

[5 Ways Parents Can Prevent Teenage Drinking]