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The Four Loko effect: Unusual cues related to alcohol tolerance

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You may wish to check out the abstract of a recent study, "The Four Loko Effect," published in the July 2011 issue of Perspectives On Psychological Science, because it relates today to a FTC modified order to resolve FTC charges of deceptive advertising. During the past few years, there have been recent reports of mass hospitalizations for alcohol intoxication following consumption of fruit-flavored, caffeinated, alcoholic drinks—especially concerning one brand in particular: Four Loko, notes the study's abstract.

It turns out that the Food and Drug Administration quickly determined that caffeine had to be the culprit. In accordance with a directive by the Food and Drug Administration, caffeine was removed from Four Loko and similar beverages.

The only problem that arose, however, related to the evidence that caffeine played a prominent role in widespread displays of intoxication is far from clear. Rather, it's likely that Four Loko-type drinks are especially effective as intoxicants because they provide alcohol in an unusual context, the recent study explains in its abstract.

Is the issue about the novel flavor context for alcohol?

Most researchers know for years now that drug tolerance partially results from an association between drug-paired stimuli and the drug effect. When these stimuli are altered, the drug-experienced individual does not display the expected tolerant response to the drug—rather, an enhanced (for example, nontolerant) response is seen, explains that study's abstract.

How this all relates to Four Loko and other similar beverages is that such similar beverages may be especially effective intoxicants because they provide a very novel flavor context for alcohol. Since the study appeared in 2011, there has been a lot of debate on the issue of novel flavor mixed with alcohol content in any given beverage.

On the other hand, an announcement by the manufacturer of Four Loko suggests (either by design or happenstance) appreciation of the contribution of alcohol-associated cues to alcohol tolerance. Currently, three years later, now in 2014, the Federal Trade Commission has approved a modified order with the marketers of the supersized, high-alcohol malt beverage Four Loko – Phusion Projects, LLC. Phusion Projects settled with the FTC in 2013 to resolve FTC charges of deceptive advertising.

The Commission alleged that Phusion Projects, LLC and its principals falsely claimed that a 23.5-ounce, 11 or 12 percent alcohol by volume can of Four Loko contains alcohol equivalent to one or two regular 12-ounce beers, and that a consumer could drink one can safely in its entirety on a single occasion. A 2013 order required Phusion Projects to file applications with the Department of the Treasury’s Alcohol and Tobacco Tax and Trade Bureau (TTB) to include an “Alcohol Facts” disclosure panel, using a specified format, on labels of products containing more than 1.2 ounces of pure alcohol (the amount in two regular drinks), and to feature those disclosure panels on its products beginning 90 days after receiving TTB approval.

Phusion Projects submitted the required applications to TTB. However, due to changes in TTB policy, Phusion’s requests were denied. The modified order now in July, 2014 provides for revised “Alcohol Facts” disclosures that are consistent with TTB’s current guidance. It also eliminates the requirement that certain Phusion products be resealable, according to the July 25, 2014 FTC news release, "FTC Approves Modified Final Order in Four Loko Deceptive Advertising Case."

The Commission vote approving the modified final order was 5-0. (FTC File No. C4382; the staff contact is Janet Evans, Bureau of Consumer Protection. The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them.

To file a complaint in English or Spanish, visit the FTC’s online Complaint Assistant or call the number listed on the website for leaving complaints. The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 2,000 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s website provides free information on a variety of consumer topics. Like the FTC on Facebook, follow them on Twitter.

The Four Loko effect

In the news of scientific research have been studies that highlight the importance of unusual cues related to alcohol tolerance. The popular, formerly caffeinated, fruity alcoholic beverage, Four Loko, has been blamed for the spike in alcohol-related hospitalizations, especially throughout college campuses, noted a May 23, 2011 news release, "The Four Loko effect." Initially, caffeine was deemed the culprit and the Food and Drug Administration ordered all traces of caffeine to be removed from Four Loko and all other similar beverages. However, according to an evaluation, "The Four Loko Effect," published in the July 2011 issue of Perspectives On Psychological Science, a journal of the Association for Psychological Science, caffeine might not be the primary cause of the spike in hospitalizations.

"Four Loko didn't have the extraordinary intoxicating effect because of caffeine, but rather because of the phenomenon of situational specificity of tolerance", says Shepard Siegel of McMaster University, according to the May 23, 2011 news release, "The Four Loko effect." Siegel wrote the article to highlight the importance of unusual cues related to alcohol tolerance.

The situational specificity of tolerance implies that alcohol will have a greater effect if administered in the presence of unusual cues, rather than in familiar settings typically associated with the drug

It has been known, at least since the time of Ivan Pavlov that our bodies prepare for food when it is time to eat, or when we smell the food cooking, or when other stimuli signal that we will soon be presented with a meal. More recently, it has also been determined that we similarly prepare for a drug.

We have experienced many pairings of certain flavors (for example, beer or wine) with the effects of alcohol. If we now experience alcohol in the presence of a novel flavor, such as an ersatz fruit flavor, we end up experiencing a heightened alcohol effect. This is because we have not associated such unusual flavors with the effects of alcohol and therefore do not make any preparatory response to lessen the drug effect.

According to Siegel, previous studies have clearly demonstrated situational specificity of tolerance to alcohol in university students. For example, in one experiment, participants were divided into groups where one was given alcohol in a familiar context – beer in a bar and the second group was given the same amount of alcohol in an unusual context – mixed with sweetened carbonated water in an office. The unusual context group became more intoxicated than the usual context group.

If someone were to continually consume a particular flavor mixed with alcohol, they would eventually form a strong association between that flavor and the effects of alcohol. This would cause the person to build a tolerance and the beverage would no longer be exceptionally intoxicating. Says Siegel, according to the May 23, 2011 news release, "Four Loko's fruit flavor hasn't been previously paired with alcohol, and because that association between flavor and alcohol hasn't been made, greater intoxication may occur."

In a different 2011 press release, the manufacturer of Four Loko, Phusion Projects, announced a new version of their drink, Four Loko XXX Limited Edition. According to that press release, "The innovative product will feature a brand new Four Loko flavor profile every four months." It's possible that changing the flavors of Four Loko might cause a person to be unable to form an association or tolerance, which increases its intoxication effect, the May 23, 2011 news release explains.

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