You probably don’t think of yourself as a drug user, but the odds would indicate that most physicians are. Your drug of choice likely is caffeine. According to a Nutrition and Behavior study, caffeine is the world’s most popular drug. A Journal of the Academy of Nutrition and Dietetics study estimates that 87% of Americans consume caffeinated beverages daily, with each person taking about 193 mg.
Caffeine has its perks. A caffeine research overview shows us that the drug boosts alertness and wakefulness, increases lipolysis, promotes glycogen resynthesis, and may lower the risk of Parkinson’s disease, among other benefits.
But you can have too much of a good thing. Caffeine Use Disorder (CUD) was first recognized in Diagnostic and Statistical Manual of Mental Disorders (DSM–5).
A Journal of Caffeine Research overview supported its inclusion in the latest DSM, noting that “a number of recent clinical studies show that a nontrivial proportion of caffeine users develops clinically meaningful features of caffeine dependence, including a persistent desire or unsuccessful efforts to cut down or control caffeine use, continued use despite harm, and a characteristic withdrawal syndrome.”
So how do you spot Caffeine Use Disorder (CUD) in yourself and patients? Here’s what research shows you should look out for. Someone with CUD exhibits at least the first three of these criteria within a 12-month period.
1. A persistent desire or unsuccessful efforts to cut down or control caffeine use
According to the Caffeine Research overview, caffeine’s addictive potential stems from the dopamine release it stimulates in the nucleus accumbens shell.
Researchers noted that amphetamines and cocaine have similar effects. Caffeine users also tend to self-report liking the drug, as well as an increased feeling of wellbeing.
2. Continued caffeine use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by caffeine
Researchers say this is due to reinforcement, which “influences rates of operant behavior, including drug use.” In other words, using the drug over time increases the likelihood of using it in the future.
Evidence supporting the reinforcing ability of caffeine include consistent selection of caffeine over placebo in humans and animals, as well the avoidance of withdrawal symptoms, according to the Caffeine Research overview.
The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) includes that withdrawal will either manifest as the syndrome itself, or caffeine consumption to relieve or avoid withdrawal. Symptoms included headache, fatigue or drowsiness, dysphoria, trouble concentrating, and even flu-like symptoms.
4. Caffeine is often taken in larger amounts or over a longer period than was intended
Like many drugs, researchers say that caffeine users will develop physiological and behavioral tolerance over time, requiring larger doses to achieve desired effects.
For example, high-tolerance caffeine users may be able to sleep, even after large doses, or may not experience the typical effects of diuresis, increased oxygen consumption, or increased blood pressure, as described in the Caffeine Research overview.
5. Recurrent caffeine use resulting in a failure to fulfill major role obligations at work, school, or home
The DSM-5 notes that signs may include being late to or absent from work or school due to caffeine use or withdrawal. This may even continue despite warnings.
A 1998 study published in Drug and Alcohol Dependence found that among a group of 162 randomly selected caffeine users, 14% continued using caffeine despite knowing it was harmful. Thirteen percent of respondents from the same study said a doctor or counselor had advised them to stop or cut back within the last year.
6. Continued caffeine use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of caffeine
According to the DSM-5, signs of caffeine-related interpersonal problems include arguments with a spouse about the consequences of caffeine consumption, resulting medical problems, or cost.
In the Drug and Alcohol Dependence study, only 2% of respondents reported using caffeine despite interpersonal problems. Researchers in the Caffeine Research study wrote that this “is not surprising given the wide availability and social acceptance of caffeine use.”
According to the DSM-5, tolerance may manifest as either an increasing amount of caffeine required to achieve desired effects, or diminished effects with the same dose of caffeine.
The Caffeine Research overview reports that caffeine tolerance has even been demonstrated in mice, rats, and monkeys. Tolerance in humans usually comes from chronic high doses, between 750-1,200 mg daily.
8. A great deal of time is spent in activities necessary to obtain caffeine, use caffeine, or recover from its effects
Recovering from excessive caffeine use may look different from individual to individual, according to the Caffeine Research overview. Genetics may predispose somebody to dependence, as with nicotine and alcohol, as well as sensitivity to the effects of caffeine.
Additionally, those who are genetically predisposed to slow caffeine metabolism are at risk for hypertension and myocardial infarction resulting from drinking coffee.
9. Craving or a strong desire or urge to use caffeine
In a study of pregnant women who were told to quit caffeine use during pregnancy, 43% said they used caffeine despite known harm.
Cravings, along with headache, nervousness, migraines, the need to stay awake, and the inability to concentrate at work were among their reasons.
Nineteen percent of the respondents in the Drug and Alcohol Dependence study said they experienced caffeine cravings.Caffeine has myriad health benefits. But like any other substance, the dose makes the poison.
Especially with the ubiquitousness of high-dose energy drinks, as well as the old standbys of coffee and soda, people have the potential to consume enormous quantities of the stimulant, possibly without realizing it.
It’s unlikely that your morning cup is going to land you in rehab, but it’s worth keeping in mind that Caffeine Use Disorder (CUD) is indeed real and has real health consequences.