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Volume 3, Issue 1 | February 2011 | niaaa Spectrum Volume 3, Issue 1 | February 2011 | http://www.spectrum.niaaa.nih.gov u.s. DePartMeNt oF health aND huMaN serVICes • National Institutes of health • National Institute on alcohol abuse and alcoholism Feature IN thIs Issue FDa exaMINeD NIaaa-suPPorteD Features 1 FDa examined NIaaa- researCh IN Its CaFFeINateD supported research in its Caffeinated alcoholic alCoholIC BeVerage reVIeW Beverage review Drinkers of caffeinated alcoholic beverages found to be much more likely 2 When too Much alcohol turns Into alcohol to get injured enough to require medical care as a result of their drinking Poisoning than people who drank only alcohol. ChartICle Percent of U.S. adults Among past­year users, who were past­year users percent with dependence 65.4 Alcohol 5.8 2 Popularity and Fans of Four loko—most of them products is an “unsafe food additive.” 27.7 Tobacco 46.1 4.1 Marijuana 8.0 1.8 Opiates 6.3 1.2 Sedatives 5.4 “addictability” of Drugs 0.93 Tranquilizers 5.0 college age—are in mourning. they are this past November, the FDa gave 0.57 Hallucinogens 2.7 0.56 Cocaine 23.9 0.49 Amphetamines 14.3 0.11 Solvents/inhalants 1.0 among u.s. adults 0.03 Heroin 27.0 expressing their grief through youtube the companies 15 days to “remedy the 70 6050 40 30 2010 0 0 10 20 30 40 50 Percent tribute videos. they are connecting on violation” of the Federal Food, Drug, Facebook groups. they are holding and Cosmetic act. Photo essay candlelight vigils. some are even 4 In your Face? buying and selling Four loko jewelry the FDa based its decision on scientific We hope Not. on eBay. research, much of it supported by NIaaa, about the effects of combining alcohol and caffeine. NeWs FroM the FIelD What Is Four Loko? 5 reducing off-Campus Four loko is a fruity-flavored beverage Drinking that comes in 23.5-ounce cans and is about 12 percent alcohol, meaning that 5 Brain’s reward Circuits each can contains the equivalent of May Contribute to nearly five standard alcoholic drinks. alcohol abuse “essentially, this is a bottle of wine in 6 Impulsivity, alcohol, a can—when you drink a can, you’ve and Violence just chugged a bottle of wine,” said aaron White, Ph.D., health scientist administrator at NIaaa. 7 Why are adolescents less sensitive to alcohol? others are more in agreement with In addition, the drinks contained a the decision by the Food and Drug large—though unspecified—amount of caffeine. Whereas a 6-ounce cup administration (FDa) to warn Four 5 QuestIoNs WIth... loko’s manufacturers, as well as three of brewed coffee has about 100 7 ralph hingson, sc.D. other makers of alcoholic energy milligrams of caffeine, these alcoholic drinks, that the caffeine in their energy drinks contained 150 milligrams or more. (1) Continued on page 3 Volume 3, Issue 1 | February 2011 ChartICle PoPularItyaND “aDDICtaBIlIty” oF Drugs aMoNg u.s. aDults among drugs used by u.s. adults, Percent of U.S. adults Among past­year users, alcohol ranks first, by far, in popularity who were past­year users percent with dependence and seventh in “addictability,” 65.4 Alcohol 5.8 according to a nationwide survey of 27.7 Tobacco 46.1 43,000 adults. More than 6 in 10 u.s. 4.1 Marijuana 8.0 adults reported past-year use of alcohol 1.8 Opiates 6.3 and, of them, about 6 percent were 1.2 Sedatives 5.4 dependent. though far less addictive 0.93 Tranquilizers 5.0 than some other drugs, alcohol’s 0.57 Hallucinogens 2.7 popularity boosts the number of Cocaine dependent users to 8 million per year, 0.56 23.9 Amphetamines nearly five times the number of people 0.49 14.3 dependent on all illicit drugs combined. 0.11 Solvents/inhalants 1.0 0.03 Heroin 27.0 tobacco is second in popularity and by 70 60 50 40 30 20 10 0 0 10 20 30 40 50 far the most addictive drug, with nearly Percent half of past-year users being dependent. after tobacco, heroin is most addictive increasing a drug’s “addictive Sources: (27 percent of past-year users), followed potential.” the speed of entry into grant BF, Dawson Da, Moss hB. by cocaine (24 percent) and amphetamines the brain varies by a drug’s chemistry Disaggregating the burden of substance (14 percent). Fewer than 1 in 10 and its route of administration, that dependence in the united states. past-year users were dependent on is, whether it is smoked, sniffed, (In Press.) Alcoholism: Clinical and Experimental Research. marijuana (8 percent); opiates; that is, injected, or ingested. Many other prescription painkillers used without or factors influence the development schindler CW, Panlilio lV, thorndike beyond the bounds of a prescription of addiction, and the full picture eB. effect of rate of delivery (6.3 percent); alcohol (5.8 percent); is not yet known. Investigators are of intravenous cocaine on self- administration in rats. Pharmacology, sedatives (5.4 percent); tranquilizers currently looking into mechanisms Biochemistry, and Behavior. 2009 (5 percent); hallucinogens (2.7 percent); involving individual vulnerability, oct;93(4):375–81. epub 2009 May 21. or solvents/inhalants (1 percent). including genetics; drug properties, including effects on brain targets; Volkow ND, Wang gJ, Fischman MW, What makes some drugs more likely to Foltin r, Fowler Js, et al. effects of and environmental variables such lead to addiction? one factor appears route of administration on cocaine as availability. to be the speed with which a drug induced dopamine transporter blockade in the human brain. Life Sciences. 2000 enters the brain, with faster delivery aug 11;67(12):1507–15. Feature WheN t oo MuCh alCohol turNs INto alCohol PoIsoNINg There is only a small safety window when it comes to alcohol. You can quickly go from too much to way too much. — Aaron White, Ph.D., health scientist administrator, NIAAA research shows that when people “People feel less sleepy and less But what are the signs of an alcohol drink alcohol and caffeine together, impaired, but when you look at their overdose? and is there a difference they are less aware of how drunk they performance—like their ability to drive between an overdose and are getting. People who do not “feel a car—they are still just as impaired alcohol poisoning? drunk” tend to drink more and often by the alcohol” as without the caffeine, miss the telltale signs of explained aaron White, Ph.D., health alcohol overdose. scientist administrator at NIaaa. Continued on page 4 2 http://www.spectrum.niaaa.nih.gov niaaa Spectrum � Continued from page 1 Caffeine masks the key sensory practically comatose from drinking as a result, in 2009, the FDa contacted warning signs of intoxication—like large amounts of alcohol and caffeine 30 manufacturers of caffeinated slowed reaction time and drowsiness— in an attempt to “drink more and party alcoholic beverages. “We asked them alerting drinkers that their body has longer,” Dr. o’Brien added questions to submit materials. We reviewed had enough alcohol. about drinking both premixed alcoholic existing scientific literature. We caffeinated beverages and the consulted with external experts. and “alcohol slows our reaction time. “mix-your-own” varieties to the we tested the products here in our labs Caffeine increases our reaction time. sParC survey. at the FDa,” said Dr. sharfstein. so caffeine counteracts some of the effects on reaction time, but doesn’t Dr. o’Brien and her colleagues found after its extensive investigation, ameliorate the other impairments that that drinkers of caffeinated alcoholic the FDa determined that the use of alcohol causes,” explained Dr. White. beverages “are much more likely [than caffeine in alcoholic beverages did drinkers of alcohol alone] to get injured not meet its “generally recognized as studies show that people who drink enough to require medical care as a safe” standard. to meet this standard, nonalcoholic caffeinated energy drinks result of their drinking.” When this products must demonstrate technical consume more alcohol when they research, also supported by NIaaa, evidence of safety that is accepted drink than people who do not consume was publicized in 2007, “it caused a by qualified experts. the FDa energy drinks. research also indicates firestorm of interest, not just nationally, communicated with four companies that college students who drink but internationally,” Dr. o’Brien said. whose products failed to meet the caffeinated alcoholic beverages are legal standard. more likely to drink larger quantities Dr. o’Brien credits NIaaa with of alcohol when they drink and to allowing her and her colleagues to as a result, the makers of Four loko drink more often. these same students expand the sParC study to investigate reformulated its product to remove are also more likely to commit sexual the implications of these drinks. the caffeine. the caffeinated alcoholic assault, sustain an unintentional injury, beverages made by the other three and need medical attention. “In 2001, [when we began sParC], manufacturers that received warnings these drinks weren’t there. NIaaa will no longer be available for sale. “there is an extremely strong allowed us to modify the study as association between drinking alcoholic time went on, giving us support and “We at the FDa looked at our role, but energy drinks and serious injury,” latitude to investigate in ways that were we just have one role in all of this. this explained Mary Claire o’Brien, M.D., relevant—even as the environment issue is a lot broader than the FDa,” associate professor of emergency changed,” she said.
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