Evaluating the Validity of Caffeine Use Disorder

A Brewed Awakening: Neuropsychiatric Effects of Caffeine in Older Adults

This article provides a current review of the literature examining caffeine use in older adults. Caffeine use is prevalent among older adults; thus, providers need to be aware of the prevalence and diagnostic criteria of caffeine use disorder versus nonproblematic use. The relationship between caffeine and various neuropsychiatric disorders, including Parkinson's disease, Alzheimer's disease, insomnia, and late-life depression, is reviewed. The neurobiological effects of caffeine are described, along with clinically relevant interactions between caffeine and common psychotropic medications.

Validation of the Turkish Version of the Caffeine Use Disorder Questionnaire in an Adult Population

The aim of this study was to examine the reliability and validity of the Turkish version of the Caffeine Use Disorder Questionnaire (CUDQ) in an adult population. In this instrument validation study, a total of 310 individuals (253 female, 57 males), with a mean age of 25.96 ± 6.29 years were included. The questionnaire consisted of 4 parts, comprising the sociodemographic characteristics, CUDQ, caffeine withdrawal symptoms, and caffeine consumption. For the evaluation of the data, confirmatory factor analysis (CFA), descriptive statistics, and the t test were used. In the reliability analysis, the Cronbach alpha internal consistency coefficient was 0.86, and the intraclass correlation coefficient was 0.83 for CUDQ. The CMIN/df was 0.54, and the model generally fits well to the structure (RMSEA = 0.08, CFI = 1, NFI = 1, GFI = 0.99, AGFI = 0.99, TLI = 1, NNFI = 1, RFI = 0.98). The findings suggested that the CUDQ has validity of structure, internal consistency, and construct validity for assessing Caffeine Use Disorder the tendency in the Turkish adult population.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-021-00688-8.

Prevalence and Correlates of Caffeine Use Disorder Symptoms Among a United States Sample

Background: The DSM-5 recognizes caffeine use disorder as a condition for further study, but there is a need to better understand its prevalence and clinical significance among the general population.

Methods: A survey was conducted among an online sample of 1006 caffeine-consuming adults using demographic quotas to reflect the U.S. population. Caffeine consumption, DSM-proposed criteria for caffeine use disorder, sleep, substance use, and psychological distress were assessed.

Results: Eight percent of the sample fulfilled DSM-proposed criteria for caffeine use disorder. These individuals consumed more caffeine, were younger, and were more likely to be cigarette smokers. Fulfilling caffeine use disorder criteria was associated with caffeine-related functional impairment, poorer sleep, some substance use, as well as greater depression, anxiety, and stress.

Conclusions: The prevalence of caffeine use disorder among the present sample suggests that the proposed diagnostic criteria would identify only a modest percentage of the general population, and that identified individuals experience significant caffeine-related distress.

A randomized controlled trial of a manual-only treatment for reduction and cessation of problematic caffeine use

BACKGROUND

Caffeine Use Disorder was added to DSM-5 as a diagnosis for further research, but few studies have been conducted to identify effective treatments. This randomized, controlled clinical trial examined the efficacy of a manual-only treatment program for caffeine cessation and reduction among individuals seeking treatment for problematic caffeine use.

METHODS

Individuals meeting at least two proposed DSM-5 diagnostic criteria for Caffeine Use Disorder were randomly assigned to receive either immediate treatment or treatment delayed by 7 weeks. The treatment consisted of a manual containing information about caffeine and instructions for gradually reducing caffeine consumption over a period of 6 weeks, with no counseling or additional support. Caffeine consumption and caffeine-related distress were assessed before treatment, 7 weeks after receiving the treatment manual (end-of-treatment), and 20 weeks post-treatment.

RESULTS

The manual-only treatment resulted in significant reductions in participants' self-reported caffeine consumption and caffeine-related distress at end-of-treatment that were sustained at 20-weeks post-treatment. Salivary caffeine levels and community observers corroborated the self-reported reductions in caffeine consumption. Comparisons between the immediate and delayed treatment groups suggest the reductions in caffeine consumption were attributable to the manualized treatment rather than spontaneous with the passage of time.

CONCLUSIONS

The present study provides evidence that a gradual caffeine reduction and cessation program may be successfully implemented using a manual-only approach. This time- and cost-effective intervention may be easily adopted by practitioners with limited time or experience with behavioral interventions who want to encourage their patients to reduce caffeine consumption.

Craving espresso: the dialetics in classifying caffeine as an abuse drug

Caffeine is the most consumed psychoactive substance in the world; in general, it is not associated to potentially harmful effects. Nevertheless, few studies were performed attempting to investigate the caffeine addiction. The present review was mainly aimed to answer the following question: is caffeine an abuse drug? To adress this point, the effects of caffeine in preclinical and clinical studies were summarized and critically analyzed taking account the abuse disorders described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). We concluded that the diagnostic criteria evidenced on DSM-V to intoxication-continued use and abstinence are not well supported by clinical studies. The fact that diagnostic criteria is not widely supported by preclinical or clinical studies may be due specially to a controversy in its exactly mechanism of action: recent literature point to an indirect, rather than direct modulation of dopamine receptors, and auto-limitant consumption due to adverse sensations in high doses. On the other hand, it reports clear withdrawal-related symptoms. Thus, based on a classical action on reward system, caffeine only partially fits its mechanism of action as an abuse drug, especially because previous research does not report a clear effect of dopaminergic activity enhance on nucleus accumbens; despite this, there are reports concerning dopaminergic modulation by caffeine on the striatum. However, based on human and animal research, caffeine withdrawal evokes signals and symptoms, which are relevant enough to include this substance among the drugs of abuse.

Caffeine use disorder: An item-response theory analysis of proposed DSM-5 criteria

INTRODUCTION

Caffeine is a common psychoactive substance with a documented addictive potential. Caffeine withdrawal has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but caffeine use disorder (CUD) is considered to be a condition for further study. The aim of the current study is (1) to test the psychometric properties of the Caffeine Use Disorder Questionnaire (CUDQ) by using a confirmatory factor analysis and an item response theory (IRT) approach, (2) to compare IRT models with varying numbers of parameters and models with or without caffeine consumption criteria, and (3) to examine if the total daily caffeine consumption and the use of different caffeinated products can predict the magnitude of CUD symptomatology.

METHODS

A cross-sectional study was conducted on an adult sample (N = 2259). Participants answered several questions regarding their caffeine consumption habits and completed the CUDQ, which incorporates the nine proposed criteria of the DSM-5 as well as one additional item regarding the suffering caused by the symptoms.

RESULTS

Factor analyses demonstrated the unidimensionality of the CUDQ. The suffering criterion had the highest discriminative value at a higher degree of latent trait. The criterion of failure to fulfill obligations and social/interpersonal problems discriminate only at the higher value of CUD latent factor, while endorsement the consumption of more caffeine or longer than intended and craving criteria were discriminative at a lower level of CUD. Total daily caffeine intake was related to a higher level of CUD. Daily coffee, energy drink, and cola intake as dummy variables were associated with the presence of more CUD symptoms, while daily tea consumption as a dummy variable was related to less CUD symptoms. Regular smoking was associated with more CUD symptoms, which was explained by a larger caffeine consumption.

CONCLUSIONS

The IRT approach helped to determine which CUD symptoms indicate more severity and have a greater discriminative value. The level of CUD is influenced by the type and quantity of caffeine consumption.

Dissociation between wanting and liking for alcohol and caffeine: A test of the Incentive Sensitisation Theory

Limited human studies have directly tested the dissociation between wanting and liking with human substance users, a core tenet of the Incentive Sensitisation Theory (IST). The aim of this study is to test the dissociation between wanting and liking in humans across two commonly used licit substances, alcohol and caffeine. The STRAP-R (Sensitivity To Reinforcement of Addictive and other Primary Rewards) questionnaire was administered to 285 alcohol users (mean age=33.30, SD= 8.83) and 134 coffee users (mean age=33.05, SD=8.10) ranging in their levels of substance use to assess wanting and liking. Findings showed that in high risk alcohol users wanting may drive alcohol consumption more so than liking, compared with low risk alcohol users. However, wanting and liking did not significantly dissociate as alcohol consumption increased. These findings partially support IST. Additionally, IST was not supported in coffee users. It is possible that caffeine functions differently at the neurological level compared with alcohol, perhaps explaining the lack of dissociation emerging in coffee users as caffeine use increased. Nevertheless, the current study makes several contributions to IST research. Future studies should focus on utilising the STRAP-R with a clinically dependent sample to test the dissociation between wanting and liking.

The Safety of Ingested Caffeine: A Comprehensive Review

Caffeine is the most widely consumed psychoactive drug in the world. Natural sources of caffeine include coffee, tea, and chocolate. Synthetic caffeine is also added to products to promote arousal, alertness, energy, and elevated mood. Over the past decade, the introduction of new caffeine-containing food products, as well as changes in consumption patterns of the more traditional sources of caffeine, has increased scrutiny by health authorities and regulatory bodies about the overall consumption of caffeine and its potential cumulative effects on behavior and physiology. Of particular concern is the rate of caffeine intake among populations potentially vulnerable to the negative effects of caffeine consumption: pregnant and lactating women, children and adolescents, young adults, and people with underlying heart or other health conditions, such as mental illness. Here, we review the research into the safety and safe doses of ingested caffeine in healthy and in vulnerable populations. We report that, for healthy adults, caffeine consumption is relatively safe, but that for some vulnerable populations, caffeine consumption could be harmful, including impairments in cardiovascular function, sleep, and substance use. We also identified several gaps in the literature on which we based recommendations for the future of caffeine research.

Concurrent Validity of Caffeine Problems and Diagnostic Criteria for Substance Use Disorders

Background: The DSM-5 proposes caffeine use disorder (CUD) as a condition for further study. The objective of this study was to report on the prevalence of CUD and rates of endorsement for each substance use disorder (SUD) criterion in relation to caffeine compared to alcohol and marijuana in a sample of adolescents presenting for medical care in the primary, adolescent, and substance use clinics at an academic medical center. Methods: A convenience sample of patients (N = 213; 66.7% female) aged 12-17 presenting for medical care completed the Composite Diagnostic Interview-Substance Abuse Module questionnaire, with questions regarding use of caffeine, alcohol, and marijuana. Descriptive analyses were used to determine prevalence of CUD and frequency of each endorsed SUD criterion as applied to caffeine versus alcohol or marijuana. Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) were used to determine psychometric properties for CUD. Results: The majority of subjects (N = 153) reported past 30-day caffeine use and of these, six (4%) met criteria for CUD. All six also met criteria for either alcohol and/or marijuana use disorders. Of the three essential CUD criteria (failure to quit, use despite harm, and withdrawal), both harm and withdrawal were endorsed significantly more often in relation to caffeine versus alcohol. Descriptive fit indices for the CUD model were excellent (CFI = 0.994, TLI = 0.991). Conclusions: In our sample, the proportion of adolescents that met proposed CUD criteria was low, suggesting that the proposed criteria would not lead to overdiagnosis of CUD. CUD was highly correlated with other SUDs.

Mechanisms of the psychostimulant effects of caffeine: implications for substance use disorders

BACKGROUND

The psychostimulant properties of caffeine are reviewed and compared with those of prototypical psychostimulants able to cause substance use disorders (SUD). Caffeine produces psychomotor-activating, reinforcing, and arousing effects, which depend on its ability to disinhibit the brake that endogenous adenosine imposes on the ascending dopamine and arousal systems.

OBJECTIVES

A model that considers the striatal adenosine A2A-dopamine D2 receptor heteromer as a key modulator of dopamine-dependent striatal functions (reward-oriented behavior and learning of stimulus-reward and reward-response associations) is introduced, which should explain most of the psychomotor and reinforcing effects of caffeine.

HIGHLIGHTS

The model can explain the caffeine-induced rotational behavior in rats with unilateral striatal dopamine denervation and the ability of caffeine to reverse the adipsic-aphagic syndrome in dopamine-deficient rodents. The model can also explain the weaker reinforcing effects and low abuse liability of caffeine, compared with prototypical psychostimulants. Finally, the model can explain the actual major societal dangers of caffeine: the ability of caffeine to potentiate the addictive and toxic effects of drugs of abuse, with the particularly alarming associations of caffeine (as adulterant) with cocaine, amphetamine derivatives, synthetic cathinones, and energy drinks with alcohol, and the higher sensitivity of children and adolescents to the psychostimulant effects of caffeine and its potential to increase vulnerability to SUD.

CONCLUSIONS

The striatal A2A-D2 receptor heteromer constitutes an unequivocal main pharmacological target of caffeine and provides the main mechanisms by which caffeine potentiates the acute and long-term effects of prototypical psychostimulants.

A brief manualized treatment for problematic caffeine use: A randomized control trial

OBJECTIVE

The goal of the present investigation was to develop and test a brief therapist-guided manualized treatment for problematic caffeine use, including cognitive-behavioral strategies and 5 weeks of progressively decreased consumption.

METHOD

Individuals seeking treatment for problematic caffeine use (mean daily caffeine consumption of 666 mg at baseline) were randomized using a waitlist-control design to receive immediate treatment (N = 33) or delayed treatment (∼6 weeks later; N = 34). A 1-hr treatment session designed to help individuals quit or reduce caffeine consumption was provided by a trained counselor along with a take-home booklet. After the treatment session, participants completed daily diaries of caffeine consumption for 5 weeks. They returned for follow-up assessments at 6, 12, and 26 weeks and had a telephone interview at 52-weeks posttreatment.

RESULTS

Treatment resulted in a significant reduction in self-reported caffeine use and salivary caffeine levels. No significant posttreatment increases in caffeine use were observed for up to 1 year follow-up. Comparisons to the waitlist-control condition revealed that reductions in caffeine consumption were due to treatment and not the passing of time, with a treatment effect size of R² = .35 for the model.

CONCLUSION

A brief 1-session manualized intervention with follow-up was efficacious at reducing caffeine consumption. Future researchers should replicate and extend these findings, as well as consider factors affecting dissemination of treatment for problematic caffeine use to those in need.