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
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American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.
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.
Addicott MA. Caffeine use disorder: a review of the evidence and future implications. Curr Addic Rep. 2014;1(3):186–92.
Ferre S. An update on the mechanisms of the psychostimulant effects of caffeine. J Neurochem. 2008;105(4):1067–79.
Garrett BE, Griffiths RR. Physical dependence increases the relative reinforcing effects of caffeine versus placebo. Psychopharmacology (Berl). 1998;139(3):195–202.
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.
Conlay LA, Conant JA, de Bros F, Wurtman R. Caffeine alters plasma adenosine levels. Nature. 1997;389(6647):136.
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.
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.
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.
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.
Stern KN, Chait LD, Johanson CE. Reinforcing and subjective effects of caffeine in normal human volunteers. Psychopharmacology (Berl). 1989;98(1):81–8.
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.
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.
James JE. Caffeine and cognitive performance: persistent methodological challenges in caffeine research. Pharmacol Biochem Behav. 2014;124:117–22.
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.
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.
Strain EC, Mumford GK, Silverman K, Griffiths RR. Caffeine dependence syndrome. Evidence from case histories and experimental evaluations. JAMA. 1994;272(13):1043–8.
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.
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.
Striley C, Griffiths RR, Cottler LB. Evaluating dependence criteria for caffeine. J Caffeine Res. 2011;1:219–25.
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.
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.
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.
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.
Wakefield JC. DSM-5, psychiatric epidemiology and the false positives problem. Epidemiol Psychiatr Sci. 2015;24(3):188–96.
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.
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.
Hughes JR, Amori G, Hatsukami DK. A survey of physician advice about caffeine. J Subst Abus. 1988;1(1):67–70.
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.
James JE, Stirling KP, Hampton BAM. Caffeine fading: behavioral treatment of caffeine abuse. Behav Ther. 1985;16:15–27.
Bryant CM, Dowell CJ, Fairbrother G. Caffeine reduction education to improve urinary symptoms. Br J Nurs. 2002;11(8):560–5.
Budney AJ, Emond JA. Caffeine addiction? Caffeine for youth? Time to act! Addiction. 2014;109(11):1771–2.
Reissig CJ, Strain EC, Griffiths RR. Caffeinated energy drinks—a growing problem. Drug Alcohol Depend. 2009;99(1–3):1–10.
Budney AJ. Are specific dependence criteria necessary for different substances: how can research on cannabis inform this issue? Addiction. 2006;101:125–33.
Hughes JR. Should criteria for drug dependence differ across drugs? Addiction. 2006;101 Suppl 1:134–41.
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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.
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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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DOI: https://doi.org/10.1007/s11920-015-0611-z