Caffeine dependence

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Caffeine dependence
Other namesCaffeine addiction
Caffeine structure.svg
Molecular structure of caffeine
Specialty Psychiatry

Caffeine dependence is a condition characterized by a set of criteria including tolerance, withdrawal symptoms, persistent desire or unsuccessful efforts to control use, and continued use despite knowledge of adverse consequences attributed to caffeine. [1] It can appear in physical dependence or psychological dependence, or both. Caffeine is one of the most common additives in many consumer products, including pills and beverages such as caffeinated alcoholic beverages, energy drinks, pain reliever medications, and colas. Caffeine is found naturally in plants such as coffee and tea and other plants. Studies have found that 89 percent of adults in the U.S. consume on average 200 mg of caffeine daily. [2] One area of concern that has been presented is the relationship between pregnancy and caffeine consumption. Repeated caffeine doses of 100mg appeared to result in smaller size at birth in newborns. When looking at birth weight however, caffeine consumption did not appear to make an impact. [3]

Contents

Dependence

Moderate physical dependence often arises from prolonged long-term caffeine use. [4]  In the human body, caffeine blocks adenosine receptors A1 and A2A. [5] Adenosine is a by-product of cellular activity, the stimulation of adenosine receptors produces feelings of tiredness and a drive for sleep. Caffeine's ability to block these receptors means the levels of the body's natural stimulants, dopamine, and norepinephrine, continue at higher levels.

Continued exposure to caffeine prompts the body to create more adenosine-receptors in the central nervous system, which increases the body's adenosine sensitivity. This reduces the stimulatory effects of caffeine by increasing tolerance. It also causes the body to suffer withdrawal symptoms (such as headaches, fatigue, and irritability) if caffeine intake decreases. [6]

The Diagnostic and Statistical Manual of Mental Disorders describes four caffeine-related disorders including intoxication, withdrawal, anxiety, and sleep. [7]

Addiction vs. dependence

Caffeine use is classified as a dependence, not an addiction. For a drug to be considered addictive, it must activate the brain's reward circuit. Caffeine, like addictive drugs, enhances dopamine signaling in the brain (is eugeroic), but not enough to activate the brain's reward circuit like addictive substances cause severe psychological dependence such as cocaine, morphine, and nicotine. [8] Caffeine dependence forms due to caffeine antagonizing the adenosine A2A receptor, [9] effectively blocking adenosine from the adenosine receptor site. This delays the onset of drowsiness and releases dopamine. [10] As of right now, caffeine withdrawal qualifies as a psychiatric condition by the American Psychiatric Association, but caffeine-use disorder does not. [11]

Professor Roland R. Griffiths, a professor of neurology at Johns Hopkins in Baltimore, strongly believes that caffeine withdrawal should be classified as a psychological disorder. [12] His research suggests that withdrawal affects 50% of habitual coffee drinkers, beginning within 12–24 hours after cessation of caffeine intake, and peaking in 20–48 hours, lasting as long as 9 days. [13] [14] In another study, he concluded that people who take in a minimum of 100 mg of caffeine per day (about the amount in one cup of coffee) can acquire a physical dependence that would trigger withdrawal symptoms, including muscle pain and stiffness, nausea, vomiting, and depressed mood, and other symptoms. [12] [6]

Physiological effects

Caffeine dependence can cause a host of physiological effects if caffeine consumption is not maintained. Commonly known caffeine withdrawal symptoms include headaches, fatigue, loss of focus, lack of motivation, mood swings, nausea, insomnia, dizziness, cardiac issues, hypertension, anxiety, and backache and joint pain; these can range in severity from mild to severe. [15] These symptoms may occur within 12–24 hours and can last two to nine days. [16] [17] [18]

Tests are still being done to get a better understanding of the effects that occur to people when they become dependent on different forms of caffeine to make it through the day. There has been research findings that suggest that the circadian cycle is not significantly changed under popular practices of caffeine consumption in the morning and during the afternoon. [19]

Children and Teenagers

According to the American Academy of Pediatrics (AAP), it is not recommended for individuals under the age of 18 to consume several caffeinated drinks in one day. If they were to consume caffeine, it is recommended to follow usage guidelines, to avoid overconsumption. [20] If they do not restrict their caffeine intake, they can become dependent on caffeine and without it suffer a variety of side effects. These include increase of heart rate and blood pressure, sleep disturbance, mood swings, and acid reflux. Caffeine's lasting effects on children's nervous and cardiovascular systems are currently unknown, and studies are still being conducted on it. Some research has suggested that caffeinated drinks should not be advertised to children as a primary audience. [21] [22]

Pregnancy effects

Pregnancy

If pregnant, it is recommended not to consume more than 200 mg of caffeine a day (though this is relative to the pregnant woman's weight). [23] If a pregnant woman consumes high levels of caffeine, it can result in low birth weight due to loss of blood flow to the placenta, [24] and could lead to health problems later in the child's life. [25] It can also result in premature labor, reduced fertility, and other reproductive issues. The American Pregnancy Association suggests "avoiding caffeine as much as possible" before and during pregnancy or discussing how to curtail dependency with a healthcare provider. [26]

Treatment

Understanding effective treatment strategies is crucial in managing caffeine dependence, a condition that has garnered increasing attention in recent years. A plethora of studies have surfaced aimed at reducing caffeine intake and alleviating withdrawal symptoms. One significant contribution comes from a comprehensive review and research agenda that undertook a thorough examination of caffeine use disorder. This review not only discusses potential diagnostic criteria but also highlights the far-reaching implications for individuals struggling with caffeine dependency. The author characterizes caffeine as a widely consumed substance, yet one that is not immune to fostering dependency. Despite its generally recognized safety profile, clinical evidence suggests a concerning trend wherein users develop a reliance on caffeine, often struggling to curtail consumption despite recurring health concerns, such as cardiovascular issues and perinatal complications. [27]

Evidence-based treatment strategies offer a beacon of hope for individuals seeking to break free from caffeine dependency. These strategies encompass a spectrum of approaches, including gradual dose tapering, intermittent fasting, diligent monitoring of caffeine intake through journaling, and the incorporation of regular exercise coupled with professional counseling.

Gradual dose tapering

One effective approach to managing caffeine dependence is gradual dose tapering, wherein individual gradually reduce their caffeine intake over time. This method allows the body to adjust to lower levels of caffeine gradually, minimizing withdrawals symptoms and discomfort. A study published in the journal of caffeine Research demonstration the efficacy of gradual dose tapering in reducing caffeine consumption among habitual users. Participants who followed a gradual tapering schedule experienced fewer withdrawal symptoms and were more successful in reducing their overall caffeine intake compared to those who abruptly stopped caffeine consumption.

Intermittent fasting

Intermittent fasting, a dietary regimen that involves alternating periods of eating and fasting, has emerged as a potential strategy for managing caffeine dependence. Research suggest that intermittent fasting may help regulate caffeine intake by creating structure periods of abstaining from caffeine consumption. Additionally, intermittent fasting has been associated with improved metabolic health and cognitive function, which may support individuals in overcoming caffeine dependence. A study published in the Journal of Nutrition and Metabolism found that participants who practiced intermittent fasting reported decreased cravings and improved energy levels compared to those who did not follow a fasting regimen.

Professional counseling

Seeking professional counseling or therapy can also be beneficial for individuals struggling with caffeine dependence. Counseling sessions provide a supportive environment for individuals to explore the underlying reasons for their caffeine consumption habits and develop coping strategies to manage cravings and withdrawal symptoms. Cognitive behavioral therapy (CBT), in particular, has shown promise in treating substance use disorders, including caffeine dependence. A meta- analysis published in the Journal of Consulting and Clinical Psychology found that CBT interventions were effective n reducing caffeine consumption and improving psychological outcomes among individuals with caffeine dependence.

Incorporating regular exercise

Regular physical exercise has been shown to have numerous benefits for overall health and well-being, including aiding in the management of caffeine dependence. Engaging in regular exercise can help individuals reduce stress, improve mood, and promote better sleep quality, all of which may contribute to reducing reliance on caffeine as a stimulant.

It is important that while many adults consume caffeine on a daily basis, withdrawal symptoms may not manifest until 12-24 hours after cessation and can persist for as long as 2-9 days. such symptoms can significantly impact daily functioning, giving rise to fatigue, headaches, irritability, nausea, mood fluctuations, flu-like systems, and dizziness. [28]

Related Research Articles

<span class="mw-page-title-main">Alcoholism</span> Problematic excessive alcohol consumption

Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records, the World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are stigmatizing and discourage seeking treatment, so clinical diagnostic terms such as alcohol use disorder or alcohol dependence are used instead.

<span class="mw-page-title-main">Caffeine</span> Central nervous system stimulant

Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used as a eugeroic (wakefulness promoter) or as a mild cognitive enhancer to increase alertness and attentional performance. Caffeine acts by blocking binding of adenosine to the adenosine A1 receptor, which enhances release of the neurotransmitter acetylcholine. Caffeine has a three-dimensional structure similar to that of adenosine, which allows it to bind and block its receptors. Caffeine also increases cyclic AMP levels through nonselective inhibition of phosphodiesterase.

<span class="mw-page-title-main">Psychopharmacology</span> Study of the effects of psychoactive drugs

Psychopharmacology is the scientific study of the effects drugs have on mood, sensation, thinking, behavior, judgment and evaluation, and memory. It is distinguished from neuropsychopharmacology, which emphasizes the correlation between drug-induced changes in the functioning of cells in the nervous system and changes in consciousness and behavior.

<span class="mw-page-title-main">Stimulant</span> Drug that increases activity of central nervous system

Stimulants are a class of drugs that increase the activity of the brain and the spinal cord. They are used for various purposes, such as enhancing alertness, attention, motivation, cognition, mood, and physical performance. Some of the most common stimulants are caffeine, nicotine, amphetamines, cocaine, and modafinil.

Caffeinism is a state of intoxication caused by excessive consumption of caffeine. This intoxication covers a variety of unpleasant physical and mental symptoms associated with the consumption of excessive amounts of caffeine.

Sleep inertia is a physiological state of impaired cognitive and sensory-motor performance that is present immediately after awakening. It persists during the transition of sleep to wakefulness, where an individual will experience feelings of drowsiness, disorientation and a decline in motor dexterity. Impairment from sleep inertia may take several hours to dissipate. In the majority of cases, morning sleep inertia is experienced for 15 to 30 minutes after waking.

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Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

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<span class="mw-page-title-main">Nicotine withdrawal</span> Process of withdrawing from nicotine addiction

Nicotine withdrawal is a group of symptoms that occur in the first few weeks after stopping or decreasing use of nicotine. Symptoms include intense cravings for nicotine, anger or irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger or weight gain, and difficulty concentrating. Withdrawal symptoms make it harder to quit nicotine products, and most methods for quitting smoking involve reducing nicotine withdrawal. Quit smoking programs can make it easier to quit. Nicotine withdrawal is recognized in both the American Psychiatric Association Diagnostic and Statistical Manual and the WHO International Classification of Diseases.

Caffeine-induced sleep disorder is a psychiatric disorder that results from overconsumption of the stimulant caffeine. Caffeine is one of the most widely consumed psychoactive drugs: almost 90% of Americans in a survey consume some type of caffeine each day. "When caffeine is consumed immediately before bedtime or .... throughout the day, sleep onset may be delayed, total sleep time reduced, normal stages of sleep altered, and the quality of sleep decreased." Caffeine reduces slow-wave sleep in the early part of the sleep cycle and can reduce rapid eye movement sleep later in the cycle. Caffeine increases episodes of wakefulness, and high doses in the late evening can increase sleep onset latency. In elderly people, there is an association between use of medication containing caffeine and difficulty in falling asleep.

<span class="mw-page-title-main">Benzodiazepine withdrawal syndrome</span> Signs and symptoms due to benzodiazepines discontinuation in physically dependent persons

Benzodiazepine withdrawal syndrome is the cluster of signs and symptoms that may emerge when a person who has been taking benzodiazepines as prescribed develops a physical dependence on them and then reduces the dose or stops taking them without a safe taper schedule.

Psychological dependence is a cognitive disorder that involves emotional–motivational withdrawal symptoms – such as anxiety or anhedonia – upon cessation of prolonged drug abuse or certain repetitive behaviors. It develops through frequent exposure to certain psychoactive substances or behaviors, which leads to an individual requiring further exposure to avoid withdrawal symptoms, as a result of negative reinforcement. Neuronal counter-adaptation is believed to play a role in generating withdrawal symptoms, which could be mediated through changes in neurotransmitter activity or altered receptor expression. Environmental enrichment and physical activity can attenuate withdrawal symptoms.

<span class="mw-page-title-main">Benzodiazepine dependence</span> Medical condition

Benzodiazepine dependence defines a situation in which one has developed one or more of either tolerance, withdrawal symptoms, drug seeking behaviors, such as continued use despite harmful effects, and maladaptive pattern of substance use, according to the DSM-IV. In the case of benzodiazepine dependence, the continued use seems to be typically associated with the avoidance of unpleasant withdrawal reaction rather than with the pleasurable effects of the drug. Benzodiazepine dependence develops with long-term use, even at low therapeutic doses, often without the described drug seeking behavior and tolerance.

<span class="mw-page-title-main">Amphetamine dependence</span> Medical condition

Amphetamine dependence refers to a state of psychological dependence on a drug in the amphetamine class. Stimulants such as amphetamines and cocaine do not cause somatic symptoms upon cessation of use but rather neurological-based mental symptoms.

<span class="mw-page-title-main">Cannabis use disorder</span> Continued use of cannabis despite clinically significant impairment

Cannabis use disorder (CUD), also known as cannabis addiction or marijuana addiction, is a psychiatric disorder defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and ICD-10 as the continued use of cannabis despite clinically significant impairment.

Caffeine-induced anxiety disorder is a subclass of the DSM-5 diagnosis of substance/medication-induced anxiety disorder.

Subjective response to alcohol (SR) refers to an individual's unique experience of the pharmacological effects of alcohol and is a putative risk factor for the development of alcoholism. Subjective effects include both stimulating experiences typically occurring during the beginning of a drinking episode as breath alcohol content (BAC) rises and sedative effects, which are more prevalent later in a drinking episode as BAC wanes. The combined influence of hedonic and aversive subjective experiences over the course of a drinking session are strong predictors of alcohol consumption and drinking consequences. There is also mounting evidence for consideration of SR as an endophenotype with some studies suggesting that it accounts for a significant proportion of genetic risk for the development of alcohol use disorder.

<span class="mw-page-title-main">Opioid withdrawal</span> Withdrawal symptoms of opiates

Opioid withdrawal is a set of symptoms arising from the sudden withdrawal or reduction of opioids where previous usage has been heavy and prolonged. Signs and symptoms of withdrawal can include drug craving, anxiety, restless legs, nausea, vomiting, diarrhea, sweating, and an increased heart rate. Opioid use triggers a rapid adaptation in cellular signalling pathways that means, when rapidly withdrawn, there can be adverse physiological effects. All opioids, both recreational drugs and medications, when reduced or stopped, can lead to opioid withdrawal symptoms. When withdrawal symptoms are due to recreational opioid use, the term opioid use disorder is used, whereas when due to prescribed medications, the term prescription opioid use disorder is used. Opioid withdrawal can be helped by the use of opioid replacement therapy, and symptoms may be relieved by the use of medications including lofexidine and clonidine.

<span class="mw-page-title-main">Caffeine-induced psychosis</span> Mental disorder

Caffeine-induced psychosis is a relatively rare phenomenon that can occur in otherwise healthy people. Overuse of caffeine may also worsen psychosis in people suffering from schizophrenia. It is characterized by psychotic symptoms such as delusions, paranoia, and hallucinations. This can happen with ingestion of high doses of caffeine, or when caffeine is chronically abused, but the actual evidence is currently limited.

References

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  2. ↑ Fulgoni, Victor L; Keast, Debra R; Lieberman, Harris R (2015-05-01). "Trends in intake and sources of caffeine in the diets of US adults: 2001–2010". The American Journal of Clinical Nutrition. 101 (5): 1081–1087. doi: 10.3945/ajcn.113.080077 . ISSN   0002-9165. PMID   25832334. S2CID   22251069.
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  15. ↑ Temple, Jennifer L.; Bernard, Christophe; Lipshultz, Steven E.; Czachor, Jason D.; Westphal, Joslyn A.; Mestre, Miriam A. (2017-05-26). "The Safety of Ingested Caffeine: A Comprehensive Review". Frontiers in Psychiatry. 8: 80. doi: 10.3389/fpsyt.2017.00080 . ISSN   1664-0640. PMC   5445139 . PMID   28603504.
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  17. ↑ Meredith, Steven E.; Juliano, Laura M.; Hughes, John R.; Griffiths, Roland R. (September 2013). "Caffeine Use Disorder: A Comprehensive Review and Research Agenda". Journal of Caffeine Research. 3 (3): 114–130. doi:10.1089/jcr.2013.0016. ISSN   2156-5783. PMC   3777290 . PMID   24761279.
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  23. ↑ American College of Obstetricians and Gynecologists (August 2010). "ACOG CommitteeOpinion No. 462: Moderate caffeine consumption during pregnancy". Obstetrics and Gynecology. 116 (2 Pt 1): 467–8. doi:10.1097/AOG.0b013e3181eeb2a1. PMID   20664420.
  24. ↑ Sajadi-Ernazarova, Karima R.; Anderson, Jackie; Dhakal, Aayush; Hamilton, Richard J. (2020), "Caffeine Withdrawal", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   28613541 , retrieved 2020-11-06
  25. ↑ "Should I limit caffeine during pregnancy?". nhs.uk. 2018-06-27. Retrieved 2020-11-06.
  26. ↑ "Caffeine Intake During Pregnancy". American Pregnancy Association. 2016-04-27. Retrieved 2020-11-06.
  27. ↑ Rodda, Simone; Booth, Natalia; McKean, Jessica; Chung, Anita; Park, Jennifer Jiyun; Ware, Paul (July 2020). "Mechanisms for the reduction of caffeine consumption: What, how and why". Drug and Alcohol Dependence. 212: 108024. doi:10.1016/j.drugalcdep.2020.108024. PMID   32442750.
  28. ↑ Juliano, Laura M.; Huntley, Edward D.; Harrell, Paul T.; Westerman, Ashley T. (August 2012). "Development of the Caffeine Withdrawal Symptom Questionnaire: Caffeine withdrawal symptoms cluster into 7 factors". Drug and Alcohol Dependence. 124 (3): 229–234. doi:10.1016/j.drugalcdep.2012.01.009. PMID   22341956.
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