Caffeine use disorder: It's real, and it warrants more attention

Caffeine is the most widely used drug in the world, researchers say

Brandon Ambrosino / February 7, 2014 Posted in Health Tagged behavioral science, addiction

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I wouldn't say I'm addicted to coffee.

Do I need it to function? Sure.

Am I grumpy without it? Who isn't?

But addicted?

I guess if you call the shaking bouts I get when I don't have easy access to coffee "being addicted," then sure, maybe.

Recent research suggests caffeine may be more addictive than we realize, leading to a habit that can be tough to kick. Four researchers, including Steven Meredith and Roland Griffiths from the Johns Hopkins School of Medicine, co-authored an article in September's Journal of Caffeine Research that argues "caffeine is the most commonly used drug in the world."

More than 90 percent of U.S. adults use caffeine regularly, the study says, and, on average, they consume about 200 mg per day. For healthy adults, the FDA says 400 mg a day is OK. But consuming much more than that can have dangerous, negative effects. And the milligrams add up quickly. A medium-size coffeehouse coffee can contain more than 300 mg, and most 16-ounce energy drinks contain between 160 and 240 mg of caffeine, Meredith says.

So we consume a lot of caffeine daily. Big deal, right?

Well, it can be. The study's authors claim that the negative effects of caffeine use can include cardiovascular problems and perinatal complications (i.e., heart stuff and being pregnant stuff).

"While many people can consume caffeine without harm, for some it produces negative effects, physical dependence, interferes with daily functioning, and can be difficult to give up, which are signs of problematic use," says Laura M. Juliano, a psychology professor at American University and one of the study's authors.

Meredith also cautions against the dangers of caffeine intoxication, "characterized by various symptoms, including nervousness, insomnia, gastrointestinal upset, tachycardia, and muscle twitches," he says. "In addition, following chronic caffeine consumption, abstinence can result in a clearly defined withdrawal syndrome consisting of headache, fatigue, drowsiness, depressed mood, irritability, difficulty concentrating, nausea, and vomiting."

That doesn't sound good. Perhaps worse, people who use caffeine excessively are "unable to reduce consumption despite knowledge of recurrent health problems associated with continued caffeine use," the study says. Which means that even if we know it's really, really bad for our health, some of us are all, "So what? Give me another latte."

Maybe this is why the latest version of the Diagnostic and Statistical Manual of Mental Disorders characterizes caffeine use disorder as "a condition for further study."

A condition? Really? Do researchers even have any solid biological evidence for caffeine dependence?

They do. It's covered in the section titled "Biological Evidence for Caffeine Dependence."

Caffeine, researchers argue, increases "positive subjective effects, including increased well-being, energy, alertness, and sociability." (All of which, by the way, are similar to the effects produced by cocaine.) Researchers observed that these effects reinforced the likelihood of future consumption. Also, this continuous reinforcement can condition our taste preferences. Meaning the reason we enjoy coffee's flavor might have less to do with the actual flavor and more to do with the caffeine buzz associated with that flavor.

All this talk about dependency is making my head hurt. Or maybe that's just the withdrawal. So how do I beat the headache? Simple. More coffee.

So if caffeine addiction is a thing—a real thing, a potentially dangerous thing—then why isn't it discussed more than it is? And why is coffee addiction, when it is brought up, treated as a joke rather than a concern?

Probably because caffeine is really, really popular.

"Because caffeine is socially acceptable in most cultures, and because it is the most widely consumed drug in the world, it is easy to forget that it is a psychoactive stimulant," Meredith says. "There are several clinically meaningful disorders related to caffeine use. However, the widespread availability and acceptability of caffeine can make it difficult to recognize or diagnose these disorders when they occur."

For instance, say I go to the doctor seeking treatment for insomnia. Even though there might be a link between my sleeping patterns and my caffeine use, I am likely to blame stress or some other factor when the doctor asks me what's going on. Because coffee is such a widely accepted part of our daily lives, I might not even think it's important to tell my doctor that I'm visiting him today in between three trips to Starbucks. For this reason, Meredith says it's important that we remind ourselves that caffeine is a drug, and that "excessive or habitual consumption will likely produce noticeable physical and/or psychological effects."

To be clear, the authors of the study aren't telling caffeiners to quit cold turkey. But if you do want to reduce your intake, Meredith suggests keeping track of your caffeine consumption in a "daily caffeine dairy." (Dear Caffeine Diary: My brain isn't working. I'll write more as soon as I have my morning cup.) He also suggests gradually reducing caffeine intake over several weeks, "by consuming fewer or smaller caffeinated beverages each week, or by gradually mixing in more decaffeinated beverages into ... caffeinated beverages. This method will help caffeine users avoid withdrawal symptoms associated with acute abstinence."

Look, I get it. Admitting that you might have a problem with caffeine is a scary thing to do. But there's no need to feel guilty about it. As with many drugs, researchers claim genotype might play a part in influencing caffeine dependency.

Hmm. I'll have to invite my dad out to coffee so we can discuss our family history.

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