Caffeinated alcoholic beverages — a growing public health problem

In the wake of multiple state bans on caffeinated alcoholic beverages (CABs) and an FDA warning to four companies to remove their products from the marketplace, an article published online today in the American Journal of Preventive Medicine delineates the scope of the public health problem and suggests areas of research that might help address it.

“Although several manufacturers of caffeinated beer have withdrawn their products from the market, there is no sign that young people have decreased the practice of combining alcohol and energy drinks,” commented lead author Jonathan Howland, PhD, Department of Community Health Sciences and Department of Emergency Medicine, Boston University. “Critically, CABs may increase alcohol-related risks in a number of different domains, but have been subject to very little systematic research.”

The article provides 44 references gathered from newspapers, magazines, and the scientific literature showing the current understanding of the effects of stimulants combined with alcohol. One study found that bar patrons who consumed CABs had a three-fold risk of leaving the bar highly intoxicated, compared to those who consumed alcohol without caffeine, and a fourfold risk of intending to drive after leaving the bar. Another compelling study concluded that students who consumed CABs had approximately double the risk of experiencing or committing sexual assault, riding with an intoxicated driver, having an alcohol-related accident, or requiring medical treatment.

The root of the problem may have started with so-called energy drinks. Depending on the brand, these beverages contain several stimulants, primarily caffeine, but also guarana, taurine, and sugar derivatives. Of the 577 caffeinated beverages listed on the Energy Fiend website in 2008, at least 130 contained more than the 0.02% caffeine limit for soft drinks imposed by the U.S. Food and Drug Administration (FDA).

Combining these energy drinks with alcohol became popular when marketers promoted the perception that energy drinks counteract the sedating effects of alcohol and related impairment and suggested that caffeine will increase enjoyment by allowing one to party for a longer time. According to a 2006 survey, 24% of college students reported mixing energy drinks with alcohol in the past month.

The FDA issued warning letters on November 17, 2010 to the following companies, indicating that further actions, including seizure of their products, is possible under federal law.

Charge Beverages Corp.: Core High Gravity HG Green, Core High Gravity HG Orange, and Lemon Lime Core Spiked
(http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm233990.htm)
New Century Brewing Co., LLC: Moonshot
(http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm234028.htm)
Phusion Projects, LLC (doing business as Drink Four Brewing Co.): Four Loko
(http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm234023.htm)
United Brands Company Inc.: Joose and Max
(http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm234002.htm)
States with previously announced bans are New York, Washington, Iowa, Kansas, Massachusetts, Oregon, and Michigan. The FDA announcement will likely pre-empt further state bans.

The article is “Caffeinated Alcoholic Beverages: An Emerging Public Health Problem” by Jonathan Howland, PhD, Damaris J. Rohsenow, PhD, Tamara Vehige Calise, DrPH, James MacKillop, PhD, and Jane Metrik, PhD. It has been published online in advance of publication in the American Journal of Preventive Medicine, Volume 40, Issue 2 (February 2011) published by Elsevier. doi: 10.1016/j.amepre.2010.10.026