Campus Overload Live: Why Four Loko is so dangerous

Nov 18, 2010

Campus Overload's Jenna Johnson chronicles national college news, drinking fads, admissions buzz and the latest exploits of interns on her blog each day. In her live chat, she answers your questions about life on campus -- and life off campus, too.

On Thursday, Jenna will be joined by Dr. Kirsten Hawkins, chief of adolescent medicine at Georgetown University Hospital. They will discuss the popular beverage Four Loko, which has found its way to college campuses across the country. Federal officials announced Wednesday that the drinks were unsafe and unapproved. Phusion Projects, the makers of Four Loko announced Tuesday night that the caffeine would be removed from their product.

What are the dangers of Four Loko? Have you run into problems on your campus? Discuss that and more with Jenna and Dr. Hawkins.

Welcome, welcome to Campus Overload Live. Today I have a very special guest joining me -- Dr. Kirsten B. Hawkins, who is the chief of adolescent medicine at Georgetown University Hospital.

I'm guessing we will get a lot of questions about alcoholic energy drinks -- like Four Loko -- which are being pulled from the market by federal officials.

I also would love to answer your questions about college admissions (fyi, the University of Virginia is bringing back early action), bed bugs in the dorms and getting along with your parents over Thanksgiving break.

Oh, and next week I plan to blog about cooking a Thanksgiving feast in the dorms -- so, in preparation, I am cooking for some friends Saturday night using only my microwave. I would love some recipes and suggestions.

Where did this drink come from? And why am I only hearing about it now? Is it "fashionable" on campuses these days?

Four Loko has been on the market for about two years (and other products have been around even longer) but it became extremely popular on many college campuses this semester.

In October, nine freshmen at Central Washington University were hospitalized after drinking Four Loko and a mix of other alcohols. When the police first arrived at the scene, they thought the students had been drugged. (You can read more about it on my blog: And the maker of Four Loko posted the police report:

That incident and others attracted a lot of publicity and prompted federal, state and college officials to push for the beverage to be banned.

But, yes, it is fashionable -- even if students are just drinking it as a joke.

My name is Kirsten Hawkins and I am an adolescent medicine specialist at Georgetown University Hospital. I maintain a clinical medical practice seeing teens ages 12-21 as well as performing clinical research.  Just this morning I saw a 20 year old college student and her mother and had conversation regarding caffienated alcoholic beverage use on her college campus.

I've never tried it.... what does it taste like?

 I tried it once and was shocked by its sugary sweetness.

I was wandering around college campuses yesterday and could only find one student who admitted to really liking the taste -- one guy compared it to motor oil, another said nail polish remover. One girl said it was like drinking Jolly Rancher candies.

I am interested to hear other reviews!

Isn't the issue for this particular drink the alcohol content and the consumption over a short period of time, thus spiking BAC? The govermental response seems a bit misguided, just doing something to do something rather than actually solving a problem. Dr. Hawkins, in your experience, do such prohibitions actually curb behavior, or do you see kids finding other avenues to consume what they want -- in this case having a rum and Coke or Red Bull and vodka? I'm not sure how to phrase this next question, but here goes. I was a college student years ago and did plenty of stupid things and I thank God no one was seriously hurt as a result. It seems that nowadays there is a closer scrutiny of the stupid things college students do today -- maybe as a result of them recording and publishing their lives online and news media filling airtime and web space with their exploits. Beyond education and enforcement of drinking laws (i.e., underage drinking, public drunkeness, etc) how much should we as society do to protect these kids? Do we or should we give the same safety net and try to protect the non-college student population of the same age as much, or do the college kids get more of a voice and focus for some reason?

I think that prohibitions can curb behavior. For example, it takes more time and investment to "mix" drinks than to purchase a ready made product. 

Does anyone believe that these kids are drinking Four Loko on its own? I'd be shocked if many aren't mixing it with beer, hard alcohol, and even drugs.

A lot of students that I have talked with describe it as a pre-game drink -- meaning they down one in their dorm room as they are getting ready to go out for the night. It gets them hyper and buzzed for a party or bar hopping.

The problem is that one Four Loko is the equivalent of four or five drinks -- which is the definition of binge drinking. They should not be having more than one Four Loko, let alone mixing it with other alcohol. (Or, even worse, illegal drugs.)

During the incident at Central Washington, the students were not just drinking Four Loko -- they were drinking a mix of different alcohols, which is always a recipe for disaster.

The makers of Four Loko have said over and over that their drink is safe if consumed in moderation.

I purchased a can of Four Loko on a recent trip to Milwaukee. Had never seen it before. Store owner said its biggest buyers were college kids and street people for the cheap but quick bang for the buck. I drank it over the course of the evening and got a nice buzz that had faded by bedtime. I don't see the problem as alcohol and caffeine, the problem is alcohol abuse. How is this product different than rum and coke, or red bull and vodka, or irish coffee for that matter? It's the abuse factor, not the product.

Actually I think it is the product. One can of Four Loko is the equivalent of 4 or more beers and a cup of coffee. The majority of women, given their body weight,  will reach a level of intoxication with the consumption of less than one can.

What are your thought on trying to revamp the drinking culture in this country from something that is taboo, to something that is more like Europe. Part of the reason people can profit from drinks called blackout in a can is because we have demonized alcohol to such an absurd degree. The whole 21 means 21 campaign is an absolute joke. By changing the drinking age to 18, HS students can learn to have a drink with their family and how to do it in a responsible setting instead of in the backyard of a frat party.

Unfortunately, Europe is experiencing the consequences of alcohol abuse as well. Rates of alcoholism are high despite the assumption that alcohol use is within the family.

How many college students are hurt or maimed each year on campus when they ride their bicycles without looking across busy streets? Shouldn't we ban bicycles? What about Irish coffee? That mixes alcohol and caffeine. Should that be banned?

 I don't have any statistics on bike accidents on college campuses. However, the difference with prepackaged drinks is in the marketing. These beverages are marketed towards younger drinkers who are trying to get drunk quick- it's effective but with often tragic consequences.

I heard on the radio this a.m. that a person "blew" something like a .108 or something ridiculously high after drinking this stuff. Is that true? Can it honestly raise your blood alcohol level that much?

Yes, one can is the equivalent of four to five drinks. The majority of women will be legally intoxicated with the consumption of less than one can and many men (it depends on body weight).

During college, our group of friends did our fair share of drinking (and, no, not all of that drinking was responsible). Post-graduation, most of us moved on to jobs, but a few still drink absurd amounts of alcohol in one sitting, most days a week. Is this OK? These friends insist that they don't have an alcohol problem.

Just because someone is in college doesn't mean it's healthy or safe to binge drink. A 2002 study found that 31 percent of college students met criteria for a diagnosis of alcohol abuse. (Even more stats)

The problem is a lot of students, parents and even college officials like to say, "It's just college, everyone drinks a lot."

And that attitude continues beyond college -- I often hear people say, "Well, if I had a family at home, I would be considered an alcoholic. But since I am single, it's okay for me to binge on a Monday night."

Lots of twentysomethings drink socially -- especially in a city like DC. And done responsibly, that's totally okay. But if your friends' drinking habits raise red flags in your mind, then there quite possibly might be a problem.

The best thing for you to do is talk with your friends -- let them know that you are worried about them and encourage them to cut back. And encourage everyone in your group to do things that don't involve alcohol.

Alcoholics Anonymous has an online list of questions to help people reflect on their drinking habits.

Attended a small college decades ago in a large college city and the college did not have a great deal of events every weekend. But did have a great time at overall at college and visiting other colleges and exploring the city. Fast forward with my own daughter, looking at colleges. What is important to a social scene/life at college. Daughter is not an extrovert but loves to get out and have a good time. I find myself looking at what else is there to do on campus but classes, e.g., college sports, school spirit, movies, entertainers brought in, lectures, etc. I can't see her in a small college in the middle of the country or no access to DC, Balt, Philly or New York. Comments welcomed!!!

Ah, the great debate of big city vs small town. It's easy for a high school senior to be enamored with the thrill of the thought of living in a major city -- that's why schools like Columbia in New York and George Washington here in DC like to use images of their host cities in admissions materials. A big city gives students instant access to events and learning opportunities.

But you can still have a fun, social college experience at a school in a small town -- actually, the feeling of community is often stronger on these campuses. (And chances are, she will actually be able to afford a movie ticket. )

The best thing your daughter can do is visit a variety of campuses and ask students what they do on the weekends. Spend a night in the dorms, talk with some students who don't work for the admissions department.

You can also check out the calendar of events on college websites -- are there a lot of things going on? Are there any events your daughter would attend if she went there?

With colleges trying to crack down on underage and unhealthy drinking, more and more offer fun, weekend activities that don't involve alcohol. Start talking with your daughter now about some of those opportunities, so when she gets to campus she already has plans in mind.

What is in it that makes it so dangerous? What's the alcohol volume percent and so on? I don't get how one energy drink could get someone so intoxicated.

It's 12%. This is significantly higher than beer.

Fruit Juice < 0.1%
Pilsner 3–6%
ESB (Bitter) 3-6%
Lager 4-5%
Porter 4-5%
Alcopops/Breezers/Coolers 4–7%
IPA (India Pale Ale) 6-7%
Cider 4–8%
Sparks 6-7%
Stout 5-10%
Sparkling  Wine 8 – 12%
Table Wine 8 – 14%
Retsina 10–11%
Barley Wine 10–15%
Wine (general) 10–15%
Port Wine 20%
Fortified Wine 17 – 22%
Liqueur 15–55%
Light Liquors 20%
Liquor/Spirits (general) 40%
Cask Strength Whisky/Rum 60%
Absinthe 55–89.5%
Neutral Grain Spirit 95%
Rectified Spirit 96%
Absolute Alcohol 99-100%

Are there any long-term health effects associated with mixing caffeine and alcohol?

There's a lot of research going on looking into this. A recent study looked at the consumption of energy drinks amongst college students and found that weekly or daily energy drink consumption was strongly associated with alcohol dependence. Mixing the two together would logically increase the risk of alcohol dependence.

Alcohol Clin Exp Res. 2010 Nov 12.

What would you think about just making the can smaller, instead of taking out the caffeine?

That's just not an option. The FDA said yesterday that creating products containing caffeine and alcohol is unsafe and illegal -- no matter what size the can is.

Phusion Projects is the Chicago company that makes Four Loko, which is the most popular brand out there right now. In 2006, they created a product called "Four Regular," which was so unsuccessful the company almost went under. They kept reformulating and making the cans bigger. They rolled out "Four Maxed" in early 2008 then "Four Loko" in late 2008 -- and the rest is history.

What is the difference between Sparks and Four Loko? Or drinking Red Bull and Vodka? Are all these dangerous to consume?

A study published two years ago surveyed more than 4000 college students at ten different universities in North Carolina. Students who reported consuming energy drinks mixed with alcohol (this could be Red Bull mixed with vodka, Four Loko, etc.)  had significantly higher prevalence of alcohol-related consequences, including being taken advantage of sexually, taking advantage of another sexually, riding with an intoxicated driver, being physically hurt or injured, and requiring medical treatment.

Acad Emerg Med. 2008 May;15(5):453-60.

The Four Loko product sounds disgusting to me, but I don't understand why Congress can tell people what to drink. Will legislators get in the way of my ordering a rum and coke at my local bar? That is booze and caffeine. What is the difference?

You aren't the only one questioning this decision.

Here are some of the differences, according to officials and experts I have talked with: Four Loko is pre-mixed by a manufacturer, so consumers are not watching and controlling how much alcohol is going into their drink. And while it is possible to mix a cocktail so that it's the equivalent of just one standard drink, a can of Four Loko creates the impression that a drinker is consuming just one standard drink.

(And also, in this example, keep in mind that there's a lot more caffeine in an energy drink than in your average Coke.)

But, yes, this latest action is not going to stop people from caffeinating their booze.

Is it possible to drink Four Loko responsibly?

According to the National Institute on Alcohol Abuse and AlcoholismExternal Web Site Icon binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration (BAC) level to 0.08% or more. This pattern of drinking usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours.

Consuming just one can of Four Loko meets this definition for most individuals.

Is this Four Loco any more dangerous than drinking Vodka and RedBull all night ?

Drinking a lot of anything all night long can be dangerous.

The problem with mixing energy drinks with alcohol is that the intense caffeine keeps drinkers awake and alert longer -- which can lead to even more drinking. That alertness also gives them confidence that they probably should not have.

A University of Floria study earlier this year found that college-aged drinkers who downed energy drinks with their alcohol were four times more likely to try to drunk drive. 

Is the FDA expected to review other drinks that mix alcohol and caffeine - such as Irish coffees?

Not that I know of -- and they probably won't because Irish coffees are usually not sold pre-mixed.

How is this different than a bartender - or people themselves- mixing red bull and vodka?

In many ways, it 's not much different than either a bartender or a user  mixing caffienated beverages with energy drinks.  There are commonly held false perceptions that the consumption of energy drinks can reverse alcohol-related impairment, including motor coordination and visual reaction time, which are crucial for driving safety. The combination of energy drinks with alcohol gives the user a false sense of control.


Is it better to work for a year or two before going to grad school? Or is it okay to just go straight there after undergrad?

It depends on your options and what you plan to study -- but if you can land a job right out of college, I highly encourage you to try working for a couple years before you start graduate school. That will give you time to make sure that you have made the right career choice and save up money.

But sometimes that's not an option, especially with the job market, so just make sure that your thoroughly research your options.

Have either of you tried it?

I cannot speak for Dr. Hawkins, but I had the opportunity to sample a fruit punch variety of Four Loko.

Have there been any cases of alcohol poisoning from this, at least when included in a night of drinking?

Dozens and dozens of cases nationally -- but keep in mind that it is not unusual for college students to be hospitalized because of alcohol. Here in DC, health officials have tied a handful of college student hospitalizations directly to alcoholic energy drinks.

I heard that DC is requiring city hospitals to report on caffeinated alcohol incidents. Is this true? When did it go into effect? Do you know whether there have been any incidents in DC?

Not to my knowledge.

Whats the real difference between Red Bull and Vodka, and the 4 Loco. As someone who has had too much Red Bull in an evening, I feel the problem would be similar. How far do you take this ban? Do we start banning bars from serving Irish Coffee?

The difference is that Four Loko is premixed by the manufacturer. With drinks like Irish coffee or Red Bull and vodka, consumers do the mixing.

Has been around for decades if not centuries. Rum and Coke, Irish coffee, Long Island iced tea, Red Bull and vodka, etc. Whether it is pre-mixed or not or sold in a 64 oz. size or not makes no difference to people who are binge drinking to get drunk anyway. Why regulate only pre-mixed drinks? We should ban all alcoholic sales... oh wait, that didn't work the first time. If the problem is kids under 21 drinking this stuff, why not go after ALL underage drinking? I don't see one type of drink (pre-mixed) as being the problem. I see people being stupid, not taking responsibility for themselves or their minor children as being the problem here.

Passing along these thoughts...

I went out and bought 10 cans of Four Loko last night just to protest this decision. How far should federal regulators go to protect college students -- who have always and will always deliberately made poor choices about alcohol -- from themselves?

Don't drink them all tonight! Save some as collectors items!


Say your roommate brings bedbugs into your dorm and ruins a lot of your stuff (besides making you temporarily homeless and a minor threat to your friends). You may feel bad for them, too, but are there legal recourses? Or could I sue the guy down the hall for bringing pests into a dorm?

I have no idea. I think most college and housing officials go out of their way to help students clean up their rooms, replace their possessions and mitigate anger to avoid lawsuits. But I wouldn't put it past some of today's college parents to consider suing...

What is it about drinking more than 5 drinks in one sitting that is the tipping point. Do the statistics point to increased alcoholism or injury/death after this point? Don't most Americans "binge" eat in the non-clinical sense of the word?

Binge drinking appears to be associated with  specific patterns of brain electrical activity in young adults that may reflect the future development of alcoholism.

Additionally, binge drinking is associated with the development of pancreatic cancer.

Cancer Causes Control. 2010 Jul;21(7):1047-59. Risk of pancreatic cancer by alcohol dose, duration, and pattern of consumption, including binge drinking: a population-based study.


Please check out a recent CDC report:

Given that reference keeps being made to this incident occurring at colleges, which prompted this whole issue, shouldn't this be an issue to be addressed by the institutions themselves and the families involved rather than politicizing it and banning it accross the board? Why is no one addressing the real problem of binge drinking in general and overall high levels of alcohol consumption?

Colleges are addressing the problem -- sometimes to the point where students get annoyed and upset.

Nearly every new student orientation includes information about drinking. On many campuses, university and city police are cracking down on parties, housing officials are cracking down on alcohol in the dorms. Some colleges now notify parents every time their child is caught drinking  (or even just carrying a six-pack into the dorms).

College drinking is just a huge, huge problem -- and it's difficult to change the culture of drinking on many campuses.

Here are a few good resources for more information:




From your own discussion: "... 31 percent of college students met criteria for a diagnosis of alcohol abuse..." "... it is not unusual for college students to be hospitalized because of alcohol..." So why are college students drunks? And why do we take it for granted? Why is getting drunk considered socially acceptable?

Why ARE college students drunks? I think part of the reason is that people still think of movies like "Animal House" when they think of the college experience. A lot of people are trying to change that -- and I think in many ways today's college students approach alcohol much differently than their parents -- but it's not something that can change over night.

Wow, it's already after 2 p.m. Thank you everyone for sending in such interesting questions. And a very special thanks to Dr. Hawkins for joining us today!

Next week we are moving the chat to Wednesday at 1 pm. The Post's food editor Joe Yonan will join us and answer questions about cooking in the dorms and eating well on a student budget.

And until then, you can find me on Twitter: @wpjenna.

In This Chat
Jenna Johnson
Jenna Johnson writes about college students and campus trends for the Post. She also runs the blog "Campus Overload," which chronicles national college news, drinking fads, admissions buzz and the latest exploits of Hill interns.
Dr. Kirsten B. Hawkins MD
Dr. Kirsten Hawkins is chief of adolescent medicine at Georgetown University Hospital and assistant professor of pediatric at Georgetown University Medical Center.
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