Chapter 08 | Caffeine and You

8. Caffeine: Addiction, Withdrawal, Disorders

January 8, 2013 By Kate Heyhoe

If quitting caffeine has been on your mind, this is the chapter to read….

Got a caffeine habit? Welcome to the human race.

Ninety percent of the world consumes caffeine every day – as coffee, tea, chocolate, soda or other buzzed-up substance.

In Asia and Russia, tea is drunk from morning to night; and coffee’s hot in Japan and Korea.
In South America, people get their fix from coffee, guarana, or yerba mate (so many choices!).
In Brazil – the world’s main coffee supplier – even toddlers drink coffee at breakfast.
Coca-Cola peps up people of all ages, in all corners of the globe.

Chocolate lovers get a caffeine-fix, too. I don’t just drink caffeine, I devour it: two bites of dark chocolate punctuate my daily lunch.

Read on to find out why caffeine is a socially acceptable, habit-forming – and some say addictive – drug. Caffeine has plenty of benefits, but it’s still a drug that can get out of control. This chapter explains these caffeine-related medical conditions (some of their symptoms may sound very familiar):

Mental health conditions can worsen when combined with caffeine, and a famous legal battle was won using the so-called “Starbucks Defense.” This chapter also covers how much caffeine is safe and when it can be lethal.

But first, the next section asks: Are you addicted to caffeine, or it just a habit?…

Caffeine Basics: Table of Contents

Caffeine: Are You Addicted?

January 8, 2013 By Kate Heyhoe

If you consume caffeine every day, in a regular fashion, you’ve either got a habit or are addicted – pick the term you prefer.

Experts quibble over whether to call caffeine addictive or just habit-forming. The difference is somewhat a matter of semantics, but not entirely.

An addiction suggests self-destructive behavior, one that poses a threat to individuals or society, as in a heroin or cocaine addiction. For most of us, caffeine doesn’t match that type of downward spiral. Caffeine’s generally not emotionally or physically destructive, though it can be in some people, and that’s when experts consider it an addiction.

Caffeine does act like other addictive substances by tripping the reward and pleasure circuits of the brain (which explains a lot about its popularity). It is undeniably habit-forming, but most of us don’t experience adverse effects from typical doses. Caffeine can even have benefits, such as lifting depression and reducing certain cancer risks, or enhancing certain mental and physical tasks.

Whatever you call it, if you’re hooked on caffeine, don’t panic: clinically speaking, caffeine is only mildly addictive or habit-forming. Most people can easily quit caffeine, if they survive the withdrawal stage. Though intense, withdrawal symptoms typically pass in a matter of days.

How has your caffeine consumption changed? If you do have a caffeine habit, chances are you now take in more caffeine than when you first started. That’s normal. It’s known as developing tolerance. When you hit that sweet spot of daily consumption, not too strong or too weak, you’ve found your setpoint, which is covered in Chapter 7.

So if you do have a caffeine jones, relax. You’re in good company. But if you’ve not developed or don’t want a caffeine habit, some experts say there’s no reason to start one.

Caffeine: Deep Addiction or Mild Dependency?

It’s not easy to tell if someone’s on caffeine.

Caffeine’s not like alcohol; it may elevate your mood, but people don’t get giddy or use it to escape from their troubles. Caffeine doesn’t make you slur your words or walk funny.

It’s typically used to sustain or enhance functionality. We trust our lives to people on caffeine: airline pilots, teachers, firefighters, even the President of the United States. In dangerous situations, we might even prefer that these people be on caffeine, to boost their alertness and performance.

Caffeine is also self-regulating, as discussed earlier, which prevents most of us from spiraling into dramatically destructive scenarios. Once our hands start to shake, we turn off the caffeine tap.

True enough. But caffeine does have a real effect on reward circuits of the brain, one that is consistent with addiction. Breaking the caffeine habit includes the same physical and mental withdrawal symptoms that define a substance as addictive. When your hands shake, yet you’re still pouring caffeine, that’s a sign your habit is out of control.

Let’s revisit what caffeine does to our neural wiring: Caffeine stimulates dopamine, a source of feel-good effects. According to some experts, it does so in areas of the brain separate from where cocaine and harder stimulants activate the neural wiring. So, caffeine activates some reward circuits, but it may do so in a manageable way.

Perhaps it’s best to view caffeine as a mildly addictive substance, one that presents benign effects or adverse risks, depending on the user and quantity ingested. And keep in mind that caffeine is biphasic: low to moderate doses create profoundly different effects from those of high doses.

Symptoms of Caffeine Addiction

What are the symptoms of caffeine addiction? As the next section shows, there is a beast known as Caffeine Use Disorder, and you only need three symptoms to qualify…

Caffeine Basics: Table of Contents

Caffeine Addiction Symptoms

January 31, 2013 By Kate Heyhoe

AddictionShip When does caffeine cause someone to lose control? For many of us, caffeine is no more habit-forming than relying on a morning shower to wake up.

But compulsive caffeine consumption – to the point where sleep is disrupted on a regular basis, or hands tremble – suggests a physical and a psychological dependence, perhaps even a mental health disorder.

The word “addiction” is an emotionally charged grenade, packed with social stigma and misconceptions. Many health professionals now use the term disorder, as in “Caffeine Use Disorder”– a condition where sufferers continue to use caffeine, even though it adversely affects them in some way. (It’s also been called caffeinism.)

But Caffeine Use Disorder isn’t fully recognized – yet. When the bible of addiction, The Diagnostic and Statistical Manual of Mental Disorder by the American Psychiatric Association, updated the 2013 edition (DSM-5), it placed Caffeine Use Disorder in the “conditions for further study” category. More scientific studies are needed, said the task force. Because caffeine is so commonly used, and to prevent over-diagnosis, Caffeine Use Disorder needs to have a higher threshold of diagnostic criteria than those used for other abuse substances.

Nevertheless, the proposed definition for Caffeine Use Disorder is illuminating. It identifies 9 symptoms, and says the first three or more are needed to present a diagnosis of Caffeine Use Disorder. Some of us may recognize particular symptoms in ourselves, such as: a strong craving for caffeine; unsuccessful efforts to cut back or stop caffeine use; and tolerance marked by the need for more caffeine to reach the same effect. See if any of these conditions apply to you or someone you know.

Caffeine Use Disorder: 3+ Symptoms

You need at least the first three symptoms (within a 12-month period). Plus, there must be a problematic pattern of caffeine use leading to clinically significant impairment or distress, according to the proposed definition for Caffeine Use Disorder.

1. A persistent desire or unsuccessful efforts to cut down or control caffeine use.

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.

3. Withdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for caffeine.

b. Caffeine (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

4. Caffeine is often taken in larger amounts or over a longer period than was intended.

5. Recurrent caffeine use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated tardiness or absences from work or school related to caffeine use or withdrawal).

6. Continued caffeine use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of caffeine (e.g., arguments with spouse about consequences of use, medical problems, cost).

7. Tolerance as defined by either of the following:

a. A need for markedly increased amounts of caffeine to achieve desired effect.

b. Markedly diminished effect with continued use of the same amount of caffeine.

8. A great deal of time is spent in activities necessary to obtain caffeine, use caffeine, or recover from its effects.

9. Craving or a strong desire or urge to use caffeine.

Having these symptoms is no guarantee you’ve got a caffeine disorder, and this is not intended to be medical advice. But if you think your caffeine habit is disrupting your life, you may want to consult your doctor.

Coming up: Quitting caffeine? Get prepared for some painful withdrawal symptoms…

Caffeine Basics: Table of Contents

Caffeine Withdrawal Symptoms: Ouch!

January 8, 2013 By Kate Heyhoe

If the world’s supply of caffeine suddenly dried up, we’d have a global headache on our hands – literally. Most of our heads would be pounding. Throngs of us would feel grumpy, dopey, sleepy, grouchy, achy, depressed, or all of these. In other words, we’d be suffering from Caffeine Withdrawal Syndrome.

Caffeine Withdrawal Syndrome was added in 2013 to The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. But why?

Apparently, people were experiencing symptoms, but doctors and patients weren’t identifying caffeine – or rather caffeine cessation – as the cause. Misdiagnoses can include flu, sinus problems, medication side effects, migraines and more. The symptom checklist helps pinpoint when caffeine, and not some other condition, might be the reason a patient is feeling so bad – bad enough to disrupt normal functioning in daily life. Or the patient may have more ambiguous feelings, like being less motivated at work or less social than normal, and these feelings can be mild or severe.

Caffeine Withdrawal Syndrome

The criteria include 3 or more of these symptoms (within 24 hours of stopping or reducing caffeine).*

1. Headache (some say it’s the worst headache of their lives)

2. Marked fatigue or drowsiness (can’t stay awake, no matter what)

3. Mood is dysphoric, depressed, or irritable (just feeling bad or unwell)

4. Difficulty concentrating (foggy brain, unfocused)

5. Flu-like symptoms (nausea, muscle-aches, vomiting, stiffness)

In addition, these symptoms must be bad enough to disrupt your world and cause distress. Social, work, and other functional parts of your life become impaired. And no medical, mental condition, or other reason can explain why you feel this way. Plus, the symptoms come on fast, starting within 12 to 24 hours of the last caffeine dose.*

Fortunately, the symptoms do go away. They peak after about a day or two, but some can last up to nine days and the headaches can occur for as long as three weeks. Ouch!

Unintentional Withdrawal – and Relief

Have you ever had to give up caffeine for a day or more? Hospital procedures, traveling, going to war (or to jail), being pregnant, fasting, religious practices – any sudden break from your caffeine routine can cause real problems in how you feel and behave.

We don’t think of daily caffeine use as being an addiction, partly because it’s so widespread. Yet symptoms of caffeine withdrawal happen as quickly as overnight (when we crave our first cup of coffee or tea).

Can’t take the pain or discomfort of withdrawal? Drink a cup of coffee, or tea, or cola. That’s right, consuming caffeine ends the symptoms in as little as 30-60 minutes. Which is why so many people would rather keep their habit. (For some people, severe withdrawal bouts mean major depression, staying in bed all day, missing important meetings or social events, not tending to children or pets, not going to work, or unbearable head pain.)

If you really want to cut out the caffeine, experts say the best way to quit is slowly. Taper off the dosage and the frequency. Give your system a chance to adapt. Even just a fraction of your normal dose, say a half-cup of coffee vs. the usual 2 cups, can be effective in stifling symptoms. And about those headaches…read the ingredients label before popping a painkiller; many painkillers include caffeine for its analgesic effects. If you take Excedrin, for instance, you may blunt the pain, but you’re still ingesting caffeine.

*Source: The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

NEXT: What are the signs of Caffeine Intoxication? It can happen to anyone of any age, even first time users…

Caffeine Basics: Table of Contents

Caffeine Intoxication: 5 Symptoms

January 8, 2013 By Kate Heyhoe

Can you get drunk on caffeine?

If you’ve ever slammed down a few too many coffees or Red Bulls and felt jitters or rapid heartbeat, you’ve experienced caffeine intoxication. You don’t even have to be a regular user: just a big blast of caffeine, or several blasts in a short period of time, can do it.

Caffeine intoxication is not the same thing as caffeine addiction. Addiction symptoms arise out of regular usage over a long period of time. Caffeine intoxication happens more immediately, when the caffeine has just been ingested or is still floating around in your system. Once the caffeine wears off, so does the intoxication. Here’s how to tell if someone may be experiencing caffeine intoxication…

Caffeine Intoxication: 5 of 12 Symptoms

Experts say to be diagnosed with “caffeine intoxication,” a person must display at least five of these symptoms, to the point where they impair a person’s social, work or other life functions.*

restlessness
nervousness
excitement
insomnia
flushed face
diuresis
gastrointestinal disturbance
muscle twitching
rambling flow of thought and speech
tachycardia or cardiac arrhythmia
periods of inexhaustibility
psychomotor agitation

*Source: The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

You, your kid, your parents – anyone (habitual user or not) can experience caffeine intoxication by taking more caffeine than the body can handle. Common sources like energy drinks, 5-Hour Energy shots, and too many Cokes and coffees can do it. Because each person’s metabolism is different, there’s no set amount of caffeine to trigger caffeine intoxication. Just three cups of coffee in grandma, for instance, or a supersize Coke in a small child, might push their caffeine limit, but it all depends on the person. Consult a medical professional if you think caffeine intoxication might be a problem.

Next: Important info about caffeine safety and toxicity…

Caffeine Basics: Table of Contents