It’s a lesson many university health officials, administrators and students have learned this semester when nights of beer pong or drunk dancing were more often replaced with trips to the emergency room, as students woke up from their experiences of drinking Four Loko, or “blackout in a can.”
“As an 18- or 19-year-old kid, it’s hard to understand that decisions you make on a Thursday night could impact the way the rest of your life turns out,” said Dr. Kevin Hill, an addiction psychiatrist at McLean Hospital in Belmont, Mass.
A female Central Washington University student almost died after being on a respirator with a BAC of 0.35, according to Linda Schactler, Director of Public Affairs at CWU.
Twenty-three students at Ramapo College in New Jersey were hospitalized with alcohol poisoning in September before the college banned Four Loko.
Florida State University sophomore Jason Keiran shot himself after drinking at least three cans of Four Loko. His friends and parents told ABC News the death was an accident, not a suicide.
Brandeis University Dean of Student Life Rick Sawyer, tried to warn students about the dangers of Four Loko.
“I am sure you have heard that there is an alcohol-based beverage that has hit the shelves which is creating havoc … Obviously, I ask you to avoid and boycott this and other similar products … You could even write to the FDA to ask them to get these products off of the market,” Sawyer wrote on Nov. 5.
Yet while university administrators across the country this fall tried to prevent the chaos resulting from Four Loko, a drink that even with various estimates contains equivalents of at least four beers and two cups of coffee, students, health officials and doctors said Four Loko, although dangerous, is just one part of a drinking culture on college campuses.
In Massachusetts, the state’s Alcoholic Beverages Control Commission banned all alcoholic drinks with caffeine implemented Nov. 18, forcing stores to remove the beverages by the end of the day.
The Commission’s ruling came one day after the FDA announced that several alcoholic beverages with caffeine, including Four Loko, were a “public health concern” and must be changed. On Nov. 16, Phusion Projects, the company that manufactures Four Loko, announced it would no longer use caffeine, guarana and taurine in the product.
The college appeal and
beyond
One mile from Brandeis at Gordon’s Liquors on Main Street, 360 cans of Four Loko were sold each weekend. It stopped when the Waltham City Council asked all liquor stores to remove the beverage the week of Nov. 12, according to the council’s Vice President Kenny Gordon.
The drink was so popular that some at Gordon’s bought it in cases of 12 cans, instead of the individual $2.59 cans. Four Loko, which comes in a 23.5 ounce can with 12 percent alcohol content and caffeine equivalents of multiple cups of coffee, is not alone however.
Caffeinated-alcoholic drinks like Sparks, Juice and Tilt also offer a similar beverage with about 10 to 12 percent alcohol content, Gordon said.
“[Kids] do what it takes to get there [drunk] and have fun because you’re in college. You live once,” Gordon said. “Times have changed. Drinking is not as taboo as it used to be.”
In addition to the cheap prices and advertising allegedly targeted towards college students, the high alcohol content is what sells.
“Most kids find it appealing to get wasted,” said Sinit Seniwongse, a freshman at George Mason University in Virginia. “Without Four Loko, kids are still pounding brews. Kids are still pounding [drinks] to get drunk.”
Four Loko is not much different than mixing Red Bull and Vodka, a drink commonly found at college parties, Seniwongse said.
“I don’t know if there’s rampant use of [Four Loko] on campus, but I’m not going to be as naïve to say that no one is drinking it,” said Jamele Adams, Associate Dean of Student Life at Brandeis.
Ashley Daset, a senior at Brandeis, said the drink is particularly dangerous with first-years.
“It only gained popularity this year because freshmen come in and don’t really know how to drink,” Daset said. “You’re aware of the health risks, but you do it anyway.”
Freshman binge drinking caused chaos at the off campus party in Roslyn, Wash. on Oct. 8 where nine CWU freshmen were hospitalized with alcohol poisoning.
“I’m sure that there were several students at this party [for whom it was] the first party they’d been to,” said Gail Farmer, Director of the Wellness Center at CWU.
Reports from intoxicated students first led to news stories about date-rape drugs at the party before the university discovered Four Loko, not date-rape drugs, was to blame, Schactler, the CWU spokesperson, said.
“Alcohol is so pervasive in our culture that people don’t think of it as a drug,” Schactler said.
In addition to popularity among college students, the media attention surrounding Four Loko this fall also affected adults.
Despite window signs advertising a 750 mL bottle of coconut rum for $19.99 or a 30 pack of Miller Lite for the same price, on Nov. 19, Christopher Bazaza asked the cashier if Gordon’s still sold Four Loko. He was soon disappointed. At the bottom of the glass refrigerator behind the cash register, the shelves that used to hold Four Loko were empty and the cases were no longer at the front of the store.
“The thing is, it’s because of the name brand—because everybody is talking about it. Screw it. I’ll try it again,” said Bazaza, a man a few years out of college who had drank Four Loko before.
When a man in his 40s asking for Four Loko walked into Gordon’s store this fall, “I warned him that it’s three cups of coffee and four beers,” Gordon said. Even after he offered him similar beverages like Juice and Tilt, he insisted on having the Four Loko.
The health risks of Four Loko
Doctors and health officials insisted that despite a culture of binge drinking and the ability to mix other energy drinks with liquor, Four Loko presents a unique danger. Some suggested that the negative attention it has drawn could raise awareness about responsible drinking.
“The problem with caffeinated alcoholic beverages is that they set folks up for drinking more than they had intended,” David R. Mcbride, Director of Student Health Services at Boston University, wrote in an e-mail.
Regarding the combination of the two drugs, “caffeine hinders the ability of a drinker to know that they’re drunk,” Dr. Hill said. The addition of caffeine to an alcoholic drink increases the chances of driving drunk, engaging in risky-sex, and suffering from alcohol poisoning.
Without the caffeine, Four Loko essentially becomes the same as a 40 ounce beer, Dr. Hill said.
“Once you take away Four Loko, another product will probably be used to fill the niche,” Dr. Hill said. “This has been going on on college campuses for decades.”
The day Phusion Products announced it would remove caffeine from its products, it insisted that drinks like Four Loko were still safe.
“We have repeatedly contended—and still believe, as do many people throughout the country—that the combination of alcohol and caffeine is safe,” Chris Hunter, Jeff Wright and Jaisen Freeman, the company’s three co-founders wrote in a statement on their website. “If it were unsafe, popular drinks like rum and colas, or Irish coffees that have been consumed safely and responsibly for years would face the same scrutiny that our products have recently faced.”
Yet Dr. Hill and Dr. Sharon Levy, who specializes in adolescent drug use at Children’s Hospital in Boston, said there is a unique danger associated with Four Loko because of the price and how the product is marketed.
“There’s really nothing magical,” Dr. Levy said. “Most of the problem is that this is irresponsible marketing.”
“There’s nobody over at Brandeis today who’s going to be drinking a whole bottle of Bailey’s Irish cream,” Dr. Hill said.
A spokesman for Phusion Projects declined to be interviewed for this story.
“It is marketed specifically to college students, which I think may represent a predatory marketing approach,” Dr. Mcbride wrote.
Dr. Mcbride noted that, when drinking, less than half of all college students binge drink. Binge drinking is defined as men consuming more than five drinks or women consuming more than four drinks on one occasion, he wrote.
“Most college students drink moderately or not at all,” according to Dr. Mcbride.
Kids that drink heavily three nights per week are at greater risk for developing alcohol problems later in life as opposed to kids who drink moderately only two nights per week, Dr. Hill said.
“This [attention on bans and regulations] is really an opportunity that sheds some light on the issue, but [is] not seen as a solution to the problem of college drinking,” Dr. Levy said.
A collegiate response
Dr. Levy explained that one of the results found from an intervention program at Syracuse University’s SUNY school is that kids do not know what their friends are drinking.
“Most college kids overestimate how much other kids are drinking,” Dr. Levy said.
Farmer, who coordinates alcohol education programs at CWU, said that most students are focused on the short-term impacts of drinking, not the long-term consequences.
Central Washington University uses a three part educational program for students. Before entering college in the fall, incoming freshman must take a two-hour online class during the summer. They also can participate in several educational programs held during a welcome weekend. Lastly, students must take a mandatory alcohol education class called Party Central.
University health officials like Farmer face a challenging dilemma with alcohol education. Federal law prohibits alcohol for anyone less than 21 years of age, yet underage college drinking is so common that sometimes programs advocating responsible drinking, not prohibition, are most effective.
“My job is to reduce harm and to reduce negative consequences,” Farmer said, noting that 98 percent of the students she works with are underage.
Still, all colleges feel obligated to prevent underage drinking.
“We work with local police to insure that those caught for underage possession, procurement, are held accountable in the local law enforcement and judicial system,” Dr. Mcbride wrote.
Dr. Levy explained that university officials can influence students’ decisions.
“What the administration says—their policies and their enforcement—counts,” she said.
At Brandeis, where nine students were transported to hospitals on Oct. 23, the night of Pachanga, a bi-annual dance hosted by the International Club on campus, nearby towns such as Watertown and Weston suffered a shortage of ambulances. No school officials attributed the hospitalizations to Four Loko, but university President Jehuda Reinharz created an ad-hoc Committee on Alcohol and Drug Policy to study alcohol and drug abuse.
“I write to you because these incidents are unprecedented in my 16 years as president, and they cause me and other members of this community great concern,” Reinharz wrote in a message to students.
Yet officials like Dr. Mcbride explained, “it is ultimately each student’s responsibility to keep themselves safe in making wise decisions.”
Some officials like Schactler used the incidents to learn about the culture of binge drinking. After interviewing CWU students at the off-campus party, she decided to watch YouTube videos of people drinking Four Loko.
“That’s where I learned that the preferred way to consume Four Loko was to chug it and then shoot vodka,” Schactler said.
“Most students really still believe they are invincible,” Farmer said.
