The Four-Loko Effect.

Area of Science:

• Pharmacology
• Neuroscience
• Public Health

Background:

• Recent reports link fruit-flavored, caffeinated alcoholic beverages (e.g., Four Loko) to mass hospitalizations for alcohol intoxication.
• Caffeine was initially implicated and subsequently removed from these drinks by FDA directive.
• The role of caffeine in widespread intoxication remains unclear, suggesting alternative explanations.

Purpose of the Study:

• To investigate the potential role of novel flavor contexts in the intoxicating effects of alcoholic beverages.
• To explore the relationship between drug-associated stimuli, tolerance, and acute drug response.
• To re-evaluate the factors contributing to the high intoxication rates associated with drinks like Four Loko.

Main Methods:

• Review of existing literature on drug tolerance and conditioned responses.
• Analysis of the pharmacological and contextual factors of high-risk alcoholic beverages.
• Examination of the impact of novel sensory environments on alcohol's physiological effects.

Main Results:

• Evidence for caffeine as the primary cause of intoxication is weak.
• Drug tolerance is known to be influenced by learned associations between drug-paired stimuli and the drug's effects.
• Altering these associated stimuli can lead to a loss of tolerance and an enhanced drug response.

Conclusions:

• Four Loko-type beverages may be potent intoxicants due to their unusual flavor context, which differs from typical alcohol consumption cues.
• This novel context may disrupt learned alcohol tolerance, leading to exaggerated intoxication effects.
• The manufacturer's actions may indicate an understanding of how alcohol-associated cues influence tolerance.