The Full Story
College students across the country were treated for alcohol poisoning after drinking inexpensive, fruity, carbonated, high-alcohol drinks with a hefty dose of added caffeine. Brand names included Four Loko, Joose, Max, Core High Gravity, Lemon Lime Core Spiked, and Moonshot. A single can of such drinks contained as much alcohol as four beers and as much caffeine as a large cup of strong coffee.
These beverages contained malt liquor plus caffeine, often along with caffeine-containing guarana and taurine. The U.S. Food and Drug Administration (FDA) ruled that there is no evidence that adding caffeine to alcoholic beverages is safe and required manufacturers to remove caffeine from caffeinated high-alcohol beverages.
Consumed quickly, a single can of a carbonated, high-alcohol beverage caused rapid intoxication. The presence of large quantities of caffeine meant that typical feelings of intoxication might be masked, even though the drinker's blood alcohol level is high. Drinkers consumed more of the beverage, not realizing that they were already drunk. Caffeine alters the way drinkers perceive the effects of their alcohol intake, but does not in any way affect the actual level of alcohol in their systems.
Studies compared college students who drank alcohol plus caffeine-containing energy drinks with students who drank alcohol alone. Those who consumed caffeine with alcohol were more likely to be intoxicated and more likely to plan to drive. Also, they were more likely to be victims or perpetrators of sexual assault, to be injured, and to require medical attention.
It is true that anyone is free to combine and drink alcohol and caffeine. Irish coffee, rum and Coke, and, more recently, spiked energy drinks (e.g. Red Bull and vodka) can be mixed at home or served in a bar. The caffeinated high-alcohol drinks, though, combined enough, or nearly enough, alcohol in a single serving to constitute binge drinking, plus enough caffeine to override the expected feelings of inebriation.
To sum up: Lots of alcohol plus lots of caffeine equals danger, with possible results ranging from sexual assault to automobile crashes to alcohol-induced coma or even death. If you believe that someone has swallowed too much alcohol, too much caffeine, or both, call Poison Control for advice 24 hours a day: 1-800-222-1222. If someone is unconscious or nearly so, call 911 immediately.
Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita
For More Information
Caffeine and alcohol (CDC)
The Week staff. (2010). The rise and fall of Four Loko. The Week.
(Background: In 2005, three college students invented the drink Four Loko®, the "four" referring to the four main ingredients: alcohol, caffeine, guarana (a plant whose seeds contain twice the amount of caffeine in coffee beans) and taurine (a natural acid in the body, sometimes called an amino acid, essential to building protein). The drink became extremely popular on college campuses. Over the next five years, numerous college students on many campuses became ill from drinking Four Loko®. Multiple Four Loko®-related deaths were also reported across the United States. Many colleges banned the drink. In November of 2010, Phusion Products, the maker of Four Loko®, voluntarily, but under pressure from the Food and Drug Administration, college administrators and parents, removed caffeine from the product. It still contains 12, 8 or 6 percent alcohol by volume.)
FDA Warning Letters issued to four makers of caffeinated alcoholic beverages: These beverages present a public health concern. Accessed 5/24/2014.
O'Brien MC, McCoy TP, Rhodes SD, Wagoner A, Wolfson W. Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Academic Emerg Med 2008; 15:453–460.
Thombs DL, O'Mara RJ, Tsukamoto M, Rossheim ME, Weiler RM, Merves ML, Goldberger BA. Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons. Addictive Behaviors 2010; 35:325–330.