Caffeine Use Disorder is the excess use of caffeine over a period of time that can have negative effects on the individual’s health, social interactions, or other areas of life.
- Understanding Caffeine Use Disorder
- Caffeine Use Disorder At A Glance
- Signs Of Caffeine Use Disorder
- Causes Of Caffeine Use Disorder
- Criteria For Caffeine Use Disorder
- Addiction Vs. Dependence
- Caffeine Addiction And Other Disorders
- Diagnosis Of Caffeine Use Disorder
- Caffeine Withdrawal Symptoms
- How Caffeine Affects The Brain
- Managing Caffeine Use Disorder
- Treatment For Caffeine Use Disorder
- Recovery From Caffeine Use Disorder
Understanding Caffeine Use Disorder
Caffeine use disorder is characterized by excessive caffeine intake over a period of time that tends to impair the social and personal functioning of an individual. It is not marked by the actual units consumed per day but its interference with the normal day to day functioning of an individual. Since caffeine is a widely accepted drug, many people don’t believe that it can be addictive. Caffeine use disorder is a collection of behavioral, cognitive, and psychological phenomena that can develop after repeated use of caffeine. This addiction disorder is characterized by the use of caffeine in patterns and amounts that lead to clinically significant distress or disturbance.
A 2017 study 1 pointed out that about 250 to 300 milligrams of caffeine per day are considered a moderate amount. This amount is roughly equivalent to three cups of coffee. Caffeine is considered a functional and beneficial substance because it can improve mood and alertness with low doses, unlike other drugs. However, at high doses, it can produce aversive intoxicating effects. In many circumstances, we fail to realize that we have grown too dependent on it due to constant consumption. A 2013 study 2 pointed out that many coffee drinkers often experience withdrawal symptoms if they skip their coffee in the morning. Some people also believe that taking increasing amounts of caffeine improves their ability to function and convinces them that they can’t function without it.
Caffeine Use Disorder At A Glance
- Caffeine use disorder is characterized by excessive caffeine intake over a period of time that tends to impair the social and personal functioning of an individual.
- Consumption of excess caffeine can be harmful and increases the risk of early death.
- Caffeine use disorder is classified as dependence and not an addiction.
- The effects of caffeine on the brain can be a lot like other disorders and can have physical symptoms.
- Caffeine withdrawal occurs when an individual experiences significant symptoms after quitting caffeine intake and is a medically recognized condition.
- This condition is so common that most people don’t realize that they are dependent on it.
- Since this disorder is not a recognized and diagnosable condition, there is no standardized treatment for caffeine addiction.
Studies reported that the prevalence of caffeine use disorder among the general population is less than or equal to 9 percent. Consumption of excess caffeine can be harmful and increases the risk of early death. A 2014 study 3 found that there was an increased risk of death from any cause or from any specific cause such as cardiovascular disease due to excess caffeine intake.
Signs Of Caffeine Use Disorder
Caffeine intoxication can cause a cluster of symptoms associated with stimulation of the brain and nervous system since caffeine is a stimulant drug. Caffeine can boost one’s energy and alertness, but there can be unpleasant symptoms associated with it. They are as follows:
- Difficulty sleeping or insomnia
- Muscle twitching
- The rambling flow of thoughts and speech
- Flushed face
- Increased heart rate
- Stomach upset
- Increased urination
Causes Of Caffeine Use Disorder
The exact cause of why people develop this disorder is still unknown. However, there may be certain factors that may contribute to developing this disorder. They are as follows:
1. Genetic Factors
Caffeine use disorder is found to be influenced by genes. Studies 4 comparing human monozygotic and dizygotic twins have shown heritabilities of caffeine use, tolerance, and withdrawal ranging from 35 percent to 77 percent. Reports 5 also found that the magnitude of caffeine dependence markers is similar to those for nicotine and alcohol. Genes in the adenosine A2A receptor gene are associated with caffeine consumption, sleep deprivation, and anxiety, blood pressure, and psychomotor vigilance. A 2006 study 6 found that this gene variant slows caffeine metabolism and individuals have been at increased risk for hypertension and myocardial infarction associated with coffee use.
A 2019 study 7 found that some people believe that they function better and are more productive with caffeine in their system. Another 2018 study 8 found that consumers are interested in coffee product quality and origin, as well as social, environmental, and economic sustainability. They tend to convince themselves that their work is better when they use caffeine for alertness and energy. This enables them to increase their caffeine consumption in hopes that they will perform better and thus develop a dependence on caffeine or caffeine use disorder.
Criteria For Caffeine Use Disorder
The criteria for any kind of substance dependence consist of a maladaptive pattern of substance use. This involves significant impairment manifested by three or more of the following symptoms within a 12 month period:
- The substance used in larger amounts over a long period of time
- A persistent desire or unsuccessful effort to control the use
- A great deal of time spent on obtaining, using, or recovering from the substance
- Forgoing important activities due to substance use
- Continued use of substances despite having recurrent or persistent psychological or physical problems likely to be caused or exacerbated by the substance
Addiction Vs. Dependence
Caffeine use disorder is classified as dependence and not an addiction. In order to consider a drug as addictive, it must activate the brain’s reward circuit. A 2010 study 9 pointed out that caffeine does enhance dopamine signaling in the brain but it is not enough to activate the brain’s reward circuit in drugs of abuse such as cocaine, morphine, and nicotine. Another 2010 study 10 found that caffeine dependence forms because caffeine antagonizes the adenosine A2A receptor, which effectively blocks adenosine from the receptor site. This tends to delay the onset of drowsiness and releases dopamine into the brain.
Research 11 also shows that people who take a minimum of 100gms of caffeine per day tend to acquire physical dependence that can trigger withdrawal symptoms such as nausea, vomiting, headache, irritability, lethargy, muscle pain or stiffness, or depressed mood. Adenosine is an inhibitory transmitter and chemical that is present in all human cells. Adenosine reduces the stimulatory effects of caffeine by increasing tolerance. Caffeine tolerance tends to develop quickly which ultimately makes an individual dependent.
Read More About Addiction Here
Caffeine Addiction And Other Disorders
The effects of caffeine on the brain can be a lot like other disorders and can have physical symptoms. It is important to seek medical attention in such cases and let your doctor know how much caffeine you are consuming daily, how frequently you are doing so, and whether you are being assessed for any other condition. For instance, a study 12 found that caffeine intoxication can produce similar symptoms as anxiety disorders. This includes panic attacks, intensifying feelings of worry, racing thoughts, making it difficult to quiet the mind, increasing agitation and shakiness, and preventing relaxation and quality sleep. Many people relieve their anxiety through the consumption of caffeine and temporarily relieve anxiety. A 1997 study 13 found that the short-term effects of caffeine display enhanced mood and alertness, improved exercise performance, improved ability to remain mentally alert even after fatigue, faster information processing speed, and heightened awareness and attention.
Other health conditions that have similar symptoms as caffeine intoxication:
- Manic episodes
- Panic disorder
- Generalized anxiety disorder –
- Sleep disorder
- Migraine and other headaches
- Viral Illness
- Sinus conditions
- Intoxication from other substances (amphetamines, sedatives, hypnotics)
- Medication-induced side effects such as akathisia
A 2003 study 14 pointed out that people who are highly sensitive should consume less than 400mg/d to avoid headaches, drowsiness, anxiety, and nausea. Another 2007 study 15 also found that excessive caffeine can even disrupt sleep. Researchers 16 have also found that subjects reported higher anxiety levels in moderate and high caffeine consumers compared to abstainers. One 2011 study reported 17 a positive correlation between energy drink consumption and perceived stress levels in undergraduate students. A 2013 study 18 found that caffeine use disorder is also often mistaken for cocaine addiction. Since caffeine is a psychostimulant that shows all the pharmacological properties of classical psychostimulants such as cocaine. Those properties can include arousal, motor activation, and reinforcing effects. However, these effects are milder for caffeine intake. Stimulant drugs are often cut with caffeine thus increasing the likelihood that caffeine withdrawal is involved in withdrawal from these drugs. Another study 19 pointed out that caffeine can also induce other related disorders such as caffeine-induced anxiety disorder and caffeine-induced sleep disorder.
Diagnosis Of Caffeine Use Disorder
The Diagnostic and Statistical Manual of Mental Disorder (DSM 5) does not recognize caffeine addiction as a disorder but it does recognize it as a condition for further study. According to the DSM 5, caffeine addiction becomes a concern that is characterized by at least three of the following criteria:
- Constant unsuccessful efforts to cut down or control caffeine consumption
- Consuming caffeine despite having a persistent or recurrent physical or psychological problem
- Withdrawal as manifested by either withdrawal syndrome for caffeine or consumption to relieve or avoid withdrawal symptoms
- Large amounts of caffeine consumption over a longer period than was intended
- Failure to fulfill major obligations at work, school, or home due to recurrent caffeine consumption
- Persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of caffeine
- Tolerance defined by either the need for consuming caffeine or diminished effect with continued use
- Excessive time spent in activities that are necessary to obtain caffeine, use caffeine or recover from its effects
- Caffeine use cravings or intense desire
Caffeine Withdrawal Symptoms
Caffeine withdrawal occurs when an individual experiences significant symptoms after quitting caffeine intake and is a medically recognized condition. These symptoms can typically appear within a day of quitting and can last up to a week. Symptoms of caffeine withdrawal include:
- Difficulty in concentrating
- Depressed mood
- Low energy
Caffeine withdrawal symptoms can be managed by gradually reducing caffeine intake instead of quitting abruptly. As compared to other addictions, the withdrawal and recovery period of caffeine use disorder is relatively short.
How Caffeine Affects The Brain
Caffeine is a widely accepted and consumed substance around the world and some people even find it difficult to function without it. Caffeine consumption has been associated with a number of negative health consequences such as anxiety, insomnia, hypertension, and others. Research 20 shows that caffeine produces a range of effects including behavioral stimulant effects associated with the drug. Additionally, a 2008 study 21 pointed out that caffeine has shown to stimulate dopaminergic activity by removing the negative modulatory effects of adenosine. It is addictive because of the way the drug affects the human brain that produces the alert feeling that people crave. After caffeine consumption, it’s absorbed through the small intestine and then the bloodstream. Since the chemical is both water and fat-soluble, the drug is able to penetrate the blood-brain barrier and enter the brain. According to one 2015 study 22 , caffeine resembles a molecule that’s naturally present in the brain called adenosine. This molecule can neatly fit in the brain cell receptors for adenosine and effectively block them off. The adenosine that is produced over time gets locked into these receptors which leads them to feel tired. However, when caffeine molecules block these receptors, they prevent tiredness from occurring and generate a sense of alertness and energy until the caffeine is metabolized.
In addition to this, a 2015 study 23 found that the brain also releases natural stimulants such as dopamine. This allows it to work more effectively when the adenosine receptors are blocked. The surplus of adenosine cues the adrenal glands to secrete adrenaline, another natural stimulant that further increases alertness and reduces feelings of tiredness. A 2015 study 22 found that the brain’s chemistry and physical characteristics change over time for people who drink caffeine regularly. The brain cells will begin to grow more adenosine receptors in order to maintain equilibrium. The tolerance of caffeine increases since the brain has more adenosine receptors. Studies 24 have found that caffeine use disorder is different from cocaine and substituted amphetamines since caffeine blocks adenosine receptors A1 and A2A. Caffeine produces psychomotor activating, reinforcing, and arousing effects. Adenosine is a by-product of cellular activity and stimulation of adenosine receptors produces feelings of tiredness and need to sleep. Caffeine’s ability to block these receptors means the levels of the body’s natural stimulants, dopamine, and norepinephrine continue to develop at higher levels. In case of withdrawal, the brain will naturally decrease the number of adenosine receptors on every cell in response to the sudden lack of caffeine. Additional research 25 shows that the addiction will break when the individual decreases the intake until the addiction ceases and the brain will reset to the base levels of adenosine.
Read More About Brain Health Here
Managing Caffeine Use Disorder
Gradually reducing your caffeine intake can go a long way to reduce the withdrawal symptoms. There are several ways you can manage your addiction
1. Assessing your caffeine consumption
It is important to calculate the amount of caffeine you consume every day. Caffeine is mainly present in coffee, but other products such as soft drinks and energy drinks also contain caffeine. Gourmet espresso, lattes, and cappuccino are typically stronger than instant coffee, soda, and other common caffeine-containing products.
2. Pay attention to what you feel
Take note if there are any side effects as well as withdrawal symptoms that may occur if you miss a regular dose of caffeine.
3. Effects of caffeine
In case of symptoms of caffeine withdrawal, consider understanding the effects and how it affects your feelings and your regular functioning of life. Ask yourself if you get irritated or experience headaches or fatigue when you have too much or too little caffeine.
Treatment For Caffeine Use Disorder
Since this disorder is not a recognized and diagnosable condition, there is no standardized treatment for caffeine addiction. A 2012 study 26 pointed out that there is a need for effective caffeine dependence treatments. It is important for certain people to avoid caffeine since it can worsen anxiety, insomnia, and cause heart issues. However, the risk of addiction can be affected by many factors and can vary from person to person. If an individual finds it difficult to cut back or limit caffeine intake, they are most likely to be dependent. In such cases, it is important to talk to your doctor about your concerns. The doctor may help you to develop coping strategies and ways to cut back or eliminate caffeine.
Recovery From Caffeine Use Disorder
This condition is so common that most people don’t realize that they are dependent on it. In case you are struggling with cutting back your caffeine intake, it is important to gradually cut back and not do it abruptly. This is because it can trigger withdrawal symptoms that can interfere with your daily function. With a little self-determination, it is possible to recover from this condition.References:
- Temple, J. L., Bernard, C., Lipshultz, S. E., Czachor, J. D., Westphal, J. A., & Mestre, M. A. (2017). The Safety of Ingested Caffeine: A Comprehensive Review. Frontiers in psychiatry, 8, 80. https://doi.org/10.3389/fpsyt.2017.00080
- Meredith, S. E., Juliano, L. M., Hughes, J. R., & Griffiths, R. R. (2013). Caffeine Use Disorder: A Comprehensive Review and Research Agenda. Journal of caffeine research, 3(3), 114–130. https://doi.org/10.1089/jcr.2013.0016
- Planning Committee for a Workshop on Potential Health Hazards Associated with Consumption of Caffeine in Food and Dietary Supplements; Food and Nutrition Board; Board on Health Sciences Policy; Institute of Medicine. Caffeine in Food and Dietary Supplements: Examining Safety: Workshop Summary. Washington (DC): National Academies Press (US); 2014 Apr 23. 5, Caffeine Effects on the Cardiovascular System. Available from: https://www.ncbi.nlm.nih.gov/books/NBK202224/
- Kendler, K. S., & Prescott, C. A. (1999). Caffeine intake, tolerance, and withdrawal in women: a population-based twin study. The American journal of psychiatry, 156(2), 223–228. https://doi.org/10.1176/ajp.156.2.223
- Kendler, K. S., Myers, J., & Prescott, C. A. (2007). Specificity of genetic and environmental risk factors for symptoms of cannabis, cocaine, alcohol, caffeine, and nicotine dependence. Archives of general psychiatry, 64(11), 1313–1320. https://doi.org/10.1001/archpsyc.64.11.1313
- Cornelis, M. C., El-Sohemy, A., Kabagambe, E. K., & Campos, H. (2006). Coffee, CYP1A2 genotype, and risk of myocardial infarction. JAMA, 295(10), 1135–1141. https://doi.org/10.1001/jama.295.10.1135
- Samoggia, A., & Riedel, B. (2019). Consumers’ Perceptions of Coffee Health Benefits and Motives for Coffee Consumption and Purchasing. Nutrients, 11(3), 653. https://doi.org/10.3390/nu11030653
- Guimarães, E. R., Leme, P. H., De Rezende, D. C., Pereira, S. P., & Dos Santos, A. C. (2018). The brand new Brazilian specialty coffee market. Journal of Food Products Marketing, 25(1), 49-71. https://doi.org/10.1080/10454446.2018.1478757
- Volkow, N. D., Wang, G. J., Fowler, J. S., Tomasi, D., Telang, F., & Baler, R. (2010). Addiction: decreased reward sensitivity and increased expectation sensitivity conspire to overwhelm the brain’s control circuit. BioEssays : news and reviews in molecular, cellular and developmental biology, 32(9), 748–755. https://doi.org/10.1002/bies.201000042
- Ribeiro, J. A., & Sebastião, A. M. (2010). Caffeine and adenosine. Journal of Alzheimer’s disease : JAD, 20 Suppl 1, S3–S15. https://doi.org/10.3233/JAD-2010-1379
- Striley, C. L., Griffiths, R. R., & Cottler, L. B. (2011). Evaluating Dependence Criteria for Caffeine. Journal of caffeine research, 1(4), 219–225. https://doi.org/10.1089/jcr.2011.0029
- Richards, G., & Smith, A. (2015). Caffeine consumption and self-assessed stress, anxiety, and depression in secondary school children. Journal of psychopharmacology (Oxford, England), 29(12), 1236–1247. https://doi.org/10.1177/0269881115612404
- Kaplan, G. B., Greenblatt, D. J., Ehrenberg, B. L., Goddard, J. E., Cotreau, M. M., Harmatz, J. S., & Shader, R. I. (1997). Dose-dependent pharmacokinetics and psychomotor effects of caffeine in humans. Journal of clinical pharmacology, 37(8), 693–703. https://doi.org/10.1002/j.1552-4604.1997.tb04356.x
- Nawrot, P., Jordan, S., Eastwood, J., Rotstein, J., Hugenholtz, A., & Feeley, M. (2003). Effects of caffeine on human health. Food additives and contaminants, 20(1), 1–30. https://doi.org/10.1080/0265203021000007840
- Malinauskas, B. M., Aeby, V. G., Overton, R. F., Carpenter-Aeby, T., & Barber-Heidal, K. (2007). A survey of energy drink consumption patterns among college students. Nutrition journal, 6, 35. https://doi.org/10.1186/1475-2891-6-35
- Gilliland, K., & Andress, D. (1981). Ad lib caffeine consumption, symptoms of caffeinism, and academic performance. The American journal of psychiatry, 138(4), 512–514. https://doi.org/10.1176/ajp.138.4.512
- Pettit, M. L., & DeBarr, K. A. (2011). Perceived stress, energy drink consumption, and academic performance among college students. Journal of American college health : J of ACH, 59(5), 335–341. https://doi.org/10.1080/07448481.2010.510163
- Ferré S. (2013). Caffeine and Substance Use Disorders. Journal of caffeine research, 3(2), 57–58. https://doi.org/10.1089/jcr.2013.0015
- Santos, V. A., Hoirisch-Clapauch, S., Nardi, A. E., & Freire, R. C. (2019). Panic Disorder and Chronic Caffeine Use: A Case-control Study. Clinical practice and epidemiology in mental health : CP & EMH, 15, 120–125. https://doi.org/10.2174/1745017901915010120
- Fredholm, B. B., Bättig, K., Holmén, J., Nehlig, A., & Zvartau, E. E. (1999). Actions of caffeine in the brain with special reference to factors that contribute to its widespread use. Pharmacological reviews, 51(1), 83–133.
- Ferré S. (2008). An update on the mechanisms of the psychostimulant effects of caffeine. Journal of neurochemistry, 105(4), 1067–1079. https://doi.org/10.1111/j.1471-4159.2007.05196.x
- Cappelletti, S., Piacentino, D., Sani, G., & Aromatario, M. (2015). Caffeine: cognitive and physical performance enhancer or psychoactive drug?. Current neuropharmacology, 13(1), 71–88. https://doi.org/10.2174/1570159X13666141210215655
- Dela Peña, I., Gevorkiana, R., & Shi, W. X. (2015). Psychostimulants affect dopamine transmission through both dopamine transporter-dependent and independent mechanisms. European journal of pharmacology, 764, 562–570. https://doi.org/10.1016/j.ejphar.2015.07.044
- Ferré, S. Mechanisms of the psychostimulant effects of caffeine: implications for substance use disorders. Psychopharmacology 233, 1963–1979 (2016). https://doi.org/10.1007/s00213-016-4212-2
- Planning Committee for a Workshop on Potential Health Hazards Associated with Consumption of Caffeine in Food and Dietary Supplements; Food and Nutrition Board; Board on Health Sciences Policy; Institute of Medicine. Caffeine in Food and Dietary Supplements: Examining Safety: Workshop Summary. Washington (DC): National Academies Press (US); 2014 Apr 23. 6, Caffeine Effects on the Central Nervous System and Behavioral Effects Associated with Caffeine Consumption. Available from: https://www.ncbi.nlm.nih.gov/books/NBK202225/
- Juliano, L. M., Evatt, D. P., Richards, B. D., & Griffiths, R. R. (2012). Characterization of individuals seeking treatment for caffeine dependence. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 26(4), 948–954. https://doi.org/10.1037/a0027246