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Evaluating the Validity of Caffeine Use Disorder

Abstract

Caffeine use disorder is included in the conditions for further study section of the DSM-5. Caffeine’s profile of neurobiological, behavioral, and clinical effects is similar to other common substances that humans use recreationally. Extant data suggest that a clinically meaningful addictive disorder develops in some regular caffeine users, but this literature is incomplete and not yet sufficient to determine if and how best to define and treat caffeine use disorder. An overview of the literature relevant to determining the clinical importance of problematic caffeine use is followed by discussion of potential concerns and benefits associated with its classification as a mental disorder. Concerns about overdiagnosis and trivialization of other psychiatric syndromes are weighed against the public health benefits of increased awareness and development of interventions targeting problematic caffeine use. This discussion includes consideration of alternative diagnostic approaches, improvement of assessment practices, and the need for additional clinical and epidemiological research.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.

    Google Scholar 

  2. 2.••

    Meredith SE, Juliano LM, Hughes JR, Griffiths RR. Caffeine use disorder: a comprehensive review and research agenda. J Caffeine Res. 2013;3(3):114–30. This paper provides a systematic review of the biological and clinical evidence for Caffeine Dependence as defined by the DSM-IV, and uses data from prior clinical studies to derive prevalence estimates of Caffeine Use Disorder using the proposed DSM-5 criteria set. The authors discuss future research needed to better understand the prevalence, etiology, and clinical significance of Caffeine Use Disorder, and to provide alternative treatment interventions to help those that desire or need to reduce or quit caffeine use.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  3. 3.

    Addicott MA. Caffeine use disorder: a review of the evidence and future implications. Curr Addic Rep. 2014;1(3):186–92.

    Article  Google Scholar 

  4. 4.

    Ferre S. An update on the mechanisms of the psychostimulant effects of caffeine. J Neurochem. 2008;105(4):1067–79.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Garrett BE, Griffiths RR. Physical dependence increases the relative reinforcing effects of caffeine versus placebo. Psychopharmacology (Berl). 1998;139(3):195–202.

    CAS  Article  Google Scholar 

  6. 6.

    Solinas M, Ferre S, You ZB, Karcz-Kubicha M, Popoli P, Goldberg SR. Caffeine induces dopamine and glutamate release in the shell of the nucleus accumbens. J Neurosci. 2002;22(15):6321–4.

    CAS  PubMed  Google Scholar 

  7. 7.

    Conlay LA, Conant JA, de Bros F, Wurtman R. Caffeine alters plasma adenosine levels. Nature. 1997;389(6647):136.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Juliano LM, Ferre S, Griffiths RR. The pharmacology of caffeine. In: Ries RK, Fiellin DA, Miller SC, Saitz R, editors. ASAM principles of addiction medicine. 5th ed. Baltimore: Lippincott Williams & Wilkins; 2014. p. 180–200.

    Google Scholar 

  9. 9.

    Juliano LM, Griffiths RR. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology (Berl). 2004;176(1):1–29.

    CAS  Article  Google Scholar 

  10. 10.

    Kendler KS, Chen X, Dick D, Maes H, Gillespie N, Neale MC, et al. Recent advances in the genetic epidemiology and molecular genetics of substance use disorders. Nat Neurosci. 2012;15(2):181–9.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  11. 11.

    Kendler KS, Schmitt E, Aggen SH, Prescott CA. Genetic and environmental influences on alcohol, caffeine, cannabis, and nicotine use from early adolescence to middle adulthood. Arch Gen Psychiatry. 2008;65(6):674–82.

    PubMed Central  Article  PubMed  Google Scholar 

  12. 12.

    Stern KN, Chait LD, Johanson CE. Reinforcing and subjective effects of caffeine in normal human volunteers. Psychopharmacology (Berl). 1989;98(1):81–8.

    CAS  Article  Google Scholar 

  13. 13.

    Silverman K, Griffiths RR. Low-dose caffeine discrimination and self-reported mood effects in normal volunteers. J Exp Anal Behav. 1992;57(1):91–107.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  14. 14.

    Silverman K, Evans SM, Strain EC, Griffiths RR. Withdrawal syndrome after the double-blind cessation of caffeine consumption. N Engl J Med. 1992;327(16):1109–14.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    James JE. Caffeine and cognitive performance: persistent methodological challenges in caffeine research. Pharmacol Biochem Behav. 2014;124:117–22.

    CAS  Article  PubMed  Google Scholar 

  16. 16.•

    Juliano LM, Evatt DP, Richards BD, Griffiths RR. Characterization of individuals seeking treatment for caffeine dependence. Psychol Addict Behav. 2012;26(4):948–54. This study provides a detailed profile of individuals seeking treatment for problematic caffeine use, including a diagnostic clinical interview of Caffeine Dependence using generic DSM-IV substance dependence criteria, and self-reported caffeine use history, reasons for seeking treatment, and general psychological functioning. Results supported the utility of a Caffeine Dependence diagnosis and underscored the need for effective treatments.

    PubMed Central  Article  PubMed  Google Scholar 

  17. 17.

    Oberstar JV, Bernstein GA, Thuras PD. Caffeine use and dependence in adolescents: one-year follow-up. J Child Adolesc Psychopharmacol. 2002;12(2):127–35.

    Article  PubMed  Google Scholar 

  18. 18.

    Strain EC, Mumford GK, Silverman K, Griffiths RR. Caffeine dependence syndrome. Evidence from case histories and experimental evaluations. JAMA. 1994;272(13):1043–8.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Jones HA, Lejuez CW. Personality correlates of caffeine dependence: the role of sensation seeking, impulsivity, and risk taking. Exp Clin Psychopharmacol. 2005;13(3):259–66.

    Article  PubMed  Google Scholar 

  20. 20.

    Hughes JR, Oliveto AH, Liguori A, Carpenter J, Howard T. Endorsement of DSM-IV dependence criteria among caffeine users. Drug Alcohol Depend. 1998;52(2):99–107.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Striley C, Griffiths RR, Cottler LB. Evaluating dependence criteria for caffeine. J Caffeine Res. 2011;1:219–25.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  22. 22.

    Svikis DS, Berger N, Haug NA, Griffiths RR. Caffeine dependence in combination with a family history of alcoholism as a predictor of continued use of caffeine during pregnancy. Am J Psychiatry. 2005;162(12):2344–51.

    Article  PubMed  Google Scholar 

  23. 23.

    Striley C, Hughes JR, Griffiths RR, Juliano LM, Budney AJ. Critical examination of the caffeine provisions in the diagnostic and statistical manual, 5th edition (DSM-5). J Caffeine Res. 2013;3(3):101–7.

    Article  Google Scholar 

  24. 24.•

    Budney AJ, Brown PC, Griffiths RR, Hughes JR, Juliano LM. Caffeine withdrawal and dependence: a convenience survey among addiction professionals. J Caffeine Res. 2013;3(2):67–71. This study evaluated beliefs about Caffeine Use Disorders among members of professional organizations that focus on addiction. Though a majority of respondents thought that Caffeine Withdrawal and Dependence existed and had clinical significance, fewer thought that Caffeine Withdrawal or Dependence should be included in the DSM.

    PubMed Central  Article  PubMed  Google Scholar 

  25. 25.

    Wakefield JC, First MB. Clarifying the boundary between normality and disorder: a fundamental conceptual challenge for psychiatry. Can J Psychiatry. 2013;58(11):603–5.

    PubMed  Google Scholar 

  26. 26.

    Wakefield JC. DSM-5, psychiatric epidemiology and the false positives problem. Epidemiol Psychiatr Sci. 2015;24(3):188–96.

    CAS  Article  PubMed  Google Scholar 

  27. 27.•

    First MB, Wakefield JC. Diagnostic criteria as dysfunction indicators: bridging the chasm between the definition of mental disorder and diagnostic criteria for specific disorders. Can J Psychiatry. 2013;58(12):663–9. This paper provides a critical review of the DSM-5 criteria for diagnosing mental disorders, which is analogous to many of the concerns related to Caffeine Use Disorder. In addition, the authors provide suggestions for a more rigorous approach for diagnosis, which includes a systematic evaluation of symptom duration and comparison to normal-range responses.

    PubMed  Google Scholar 

  28. 28.

    Wakefield JC, Schmitz MF. The harmful dysfunction model of alcohol use disorder: revised criteria to improve the validity of diagnosis and prevalence estimates. Addiction. 2015;110(6):931–42.

    Article  PubMed  Google Scholar 

  29. 29.

    Hughes JR, Amori G, Hatsukami DK. A survey of physician advice about caffeine. J Subst Abus. 1988;1(1):67–70.

    CAS  Article  Google Scholar 

  30. 30.

    Anderson BL, Juliano LM, Schulkin J. Caffeine’s implications for women’s health and survey of obstetrician-gynecologists’ caffeine knowledge and assessment practices. J Womens Health (Larchmt). 2009;18(9):1457–66.

    Article  Google Scholar 

  31. 31.

    James JE, Stirling KP, Hampton BAM. Caffeine fading: behavioral treatment of caffeine abuse. Behav Ther. 1985;16:15–27.

    Article  Google Scholar 

  32. 32.

    Bryant CM, Dowell CJ, Fairbrother G. Caffeine reduction education to improve urinary symptoms. Br J Nurs. 2002;11(8):560–5.

    Article  PubMed  Google Scholar 

  33. 33.

    Budney AJ, Emond JA. Caffeine addiction? Caffeine for youth? Time to act! Addiction. 2014;109(11):1771–2.

    Article  PubMed  Google Scholar 

  34. 34.

    Reissig CJ, Strain EC, Griffiths RR. Caffeinated energy drinks—a growing problem. Drug Alcohol Depend. 2009;99(1–3):1–10.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  35. 35.

    Budney AJ. Are specific dependence criteria necessary for different substances: how can research on cannabis inform this issue? Addiction. 2006;101:125–33.

    Article  PubMed  Google Scholar 

  36. 36.

    Hughes JR. Should criteria for drug dependence differ across drugs? Addiction. 2006;101 Suppl 1:134–41.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Alan Budney was a member of the DSM-5 work group on Substance Use Disorders and has received grants from the NIH.

Laura Juliano was a consultant to the DSM-5 work group on Substance Use Disorders and has received grants from the NIH.

Dustin Lee has received grants from the NIH.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Alan J. Budney.

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This article is part of the Topical Collection on Psychiatric Diagnosis

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Budney, A.J., Lee, D.C. & Juliano, L.M. Evaluating the Validity of Caffeine Use Disorder. Curr Psychiatry Rep 17, 74 (2015). https://doi.org/10.1007/s11920-015-0611-z

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Keywords

  • Caffeine use disorder
  • Caffeine dependence
  • Diagnosis
  • DSM-5