The Four Loko Effect?

In the fall of 2010, 17 students at New Jersey’s Ramapo College, along with six of their friends, were hospitalized for severe alcohol intoxication after a night of partying. Soon after, a similar event occurred at Central Washington State College, where nine students became ill and required hospitalization. One student reportedly had a blood alcohol level of .3 percent, dangerously high. The culprit in both these cases was identified as Four Loko, a caffeinated, fruit-flavored malt beverage that had been on the market since 2005. Ramapo immediately banned the drink from campus, as did the state of Washington. As other reports of injuries and blackouts came in from around the country, dozens of other colleges and universities followed suit, warning students to avoid the beverages or banning them entirely.

In November 2010, the U.S. Food and Drug Administration effectively banned caffeinated alcoholic beverages. The agency warned four brewers, including Phusion Projects, which makes Four Loko, that these “energy drinks” were a public health concern—and that they could only remain on the market if the caffeine was removed. The companies complied, decaffeinating their products, but not before entrepreneurs bought up huge quantities of the energy drinks, creating an expensive black market for what became known as “blackout in a can.”

The appeal of Four Loko and similar drinks, for its largely youthful market, is obviously getting drunk—but not in the usual way. Some clinicians believe the caffeine, a stimulant, counters the soporific effects of alcohol—so that drinkers can stay awake longer, and consume more alcohol, before passing out. That is what the FDA believed and argued—and that was the rationale for the ban on caffeine as an ingredient.

But the scientific evidence on this point is far from conclusive, and some questions still need answers. For example, Phusion Projects itself argued—in defending Four Loco—that the drink was really “comparable to having coffee after a meal with a couple glasses of wine.” And the company has a point. Four Loko should have the same effect as wine and coffee—but it doesn’t, and why not? Why does this particular beverage leave people so inebriated that they require emergency hospitalization?
Psychological scientist Shepard Siegel of McMaster University, Ontario, thinks he may have an answer, and if he’s right, even the decaffeinated energy drinks still on the market may pose a health threat for some. The real culprit in Four Loko, Siegel argues, may not be the caffeine at all, but rather the fruit flavors—and their effect on alcohol tolerance.

Four Loko doesn’t taste like beer or other malt beverages. Instead it tastes like fruit: watermelon, lemon lime, blue raspberry, and so forth. This is significant, Siegel says, because of the psychology of alcohol tolerance. It’s been known for many years that drugs—including alcohol—have an enhanced effect if taken in connection with unfamiliar cues. So, for example, people who only drink at home, in the den after dinner, will likely get higher when they drink at a wedding—even though they drink exactly the same amount of booze. Similarly, a habitual scotch drinker comes to associate alcohol with the taste of scotch, and as a result becomes more tolerant of scotch’s alcoholic content over time. It takes more scotch to get a buzz. But if that scotch drinker consumes the same amount of alcohol in a novel form—say as a banana daiquiri—then he or she will respond like a less experienced drinker.

This robust phenomenon is known in the jargon of the field as “situational specificity of tolerance,” and it can be explained this way: Tolerance gets connected to specific cues because—out of our awareness—we prepare ourselves for the physiological consequences of alcohol intake as soon as we see a cue that alcohol is on its way. This preparation tends to diminish alcohol’s effect, leading to tolerance over time.

Siegel proposes, writing in the on-line version of the journal Perspectives on Psychological Science, that this may be what’s occurring with Four Loko. He cites one food critic, who described Four Loko as “malt liquor in confectionary drag.” It’s synthetically fruity and “biliously colored”—in short, not the customary taste and look of booze. Four Loko may be especially potent as an intoxicant because of its unfamiliar cues.

In theory, of course, one could become a regular watermelon Four Loko drinker—just as some are martini drinkers and others Cabernet drinkers. Tolerance would develop the same way over time. The problem may come from Four Loko aficionados switching around—drinking watermelon one time, then cranberry-lemonade, and so forth. The switching of flavors—situational cues—weakens tolerance, increasing the chances of drunkenness and blackouts.

Such switching may be more likely now, Siegel believes, because of Four Loko’s newest marketing strategy. Earlier this year, Phusion Projects announced a new product, called Four Loko XXX Limited Edition. This drink is now available in four new fruit flavors, but—more important in terms of psychology and tolerance—each flavor is available for only four months. What that means is that even if a drinker comes to like—and tolerate—Green Apple Limited Edition, that flavor will soon be gone, to be replaced by Blueberry Lemonade, with new and unfamiliar cues.

Wray Herbert’s book, On Second Thought, will soon be out in paperback. Excerpts from his two blogs—“We’re Only Human” and “Full Frontal Psychology”—appear regularly in Scientific American Mind and The Huffington Post.