Evaluating Dependence Criteria for Caffeine

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.

SODA MAPS: A Framework for Understanding Caffeinated Sugary Drink Consumption Among Children

Excess sugary drink (SD) consumption is associated with childhood obesity and development of cardiometabolic disease. In addition to having high added sugar content, many SDs also contain caffeine, which may further encourage excess SD consumption among children. The objective of this study was to develop a conceptual framework of children's caffeinated SD consumption using group concept mapping, an applied social research multimethodology that collectively harnesses qualitative and quantitative data from participants to generate a visual representation of their ideas and input. Children, 8–14 years old, who reported consuming ≥12 ounces of caffeinated SDs (e.g., sodas, sweet teas) per day were recruited throughout Washington, D.C. and invited to participate. Concept mapping included three participant-driven activities: (1) brainstorming (n = 51), during which children reported reasons for their SD consumption, from which 58 unique reasons were identified; (2) sorting (n = 70), during which children sorted each of the reported reasons into categories and named each category; and (3) rating (n = 74), during which children rated the influence of each reason on their own caffeinated SD consumption. Similarity matrices, multidimensional scaling, and hierarchical cluster analysis were used to generate concept maps (hereafter “SODA MAPS”), which display the 58 reasons organized within eight overarching clusters. Among these eight clusters, Taste and Feel, Something to Do, and Energy were rated as particularly influential. Children's caffeinated SD consumption is encouraged not only by the palatable taste and reported preferences for these beverages (e.g., Taste and Feel), but also by psychological (e.g., Mood and Focus), biological (e.g., Energy), social (e.g., Something to Do) and environmental reasons (e.g., Nothing Better Available). Thus, the SODA MAPS can inform the development of tailored, multi-level SD reduction interventions that incorporate strategies to address important and currently overlooked reasons for caffeinated SD consumption among children.

Patterns of Caffeine Use and Validation of Assessment in Psychiatric Population: An Implication in Primary Care Setting

Background:

Caffeine use and abuse is a concern among treatment seekers for psychological problems. This aspect has not been documented an Indian context as well as its relevance in primary care setting. The aim of the present study was to explore and compare the caffeine intake and prevalence in Indian psychiatric patients and healthy subjects.

Materials and Methods:

Caffeine analysis in urine samples was carried out using a gold technique, gas chromatograph and mass selective detectors. This analytical technique is highly sensitive for identification of unambiguous compound. Two hundred and forty-three subjects having psychiatric disorders, along with forty-two healthy subjects were included in the study. They were assessed by using structured interview for caffeine use and screened for substance dependence as well.

Results:

One hundred twenty-eight subjects had history of substance use along with other comorbid psychiatric problems The mean of caffeine values was 1459 ± 1140 ng/mL, Whereas 42 subjects in control group (male 26, female 16) in the age group of 21–60 years had the mean caffeine levels of 1023 ± 788.8 ng/mL. The Caffeine use was significantly higher (P ≥ 0.84) in the subjects with psychiatric problems in comparison to the healthy subjects.

Conclusions:

It implies the need to enable and sensitize the primary care physicians in screening and educating treatment seekers with psychiatric morbidities for the management of caffeine use.

Beyond taste and easy access: Physical, cognitive, interpersonal, and emotional reasons for sugary drink consumption among children and adolescents

Consumption of sugary drinks is associated with the development of obesity and cardiometabolic diseases among children and adolescents. In addition to high added sugar content, many sugary drinks also contain caffeine. However, whether the combination of sugar and caffeine uniquely influences children's sugary drink intake is presently unknown. This study aimed to evaluate contextual factors surrounding children's sugary drink consumption and investigate reasons for sugary drink intake among children and adolescents, with a specific focus on caffeinated sodas and sweet tea. We also evaluated how sugary drink consumption makes children feel and how they anticipated that they would respond if sugary drinks were restricted. Focus group discussions (n = 9, 2-8 participants per group) were conducted with 37 predominantly AfricanAmerican children and adolescents, ages 8-14 years, who consumed ≥1 caffeine-containing sugary drink(s) daily, based on parental report. Focus groups were audio-recorded and transcribed verbatim. Transcripts were independently coded by two coders, after which emergent themes were identified. Reported reasons for sugary drink consumption encompassed five themes: 1) perceived need (e.g., satisfy cravings, quench thirst); 2) physical and cognitive benefits (e.g., provide energy, improve attention); 3) emotional and interpersonal benefits (e.g., relieve anger, facilitate socializing); 4) sensory properties (e.g., taste, carbonation); and, 5) external cues (e.g., family/peer modeling, availability). Negative consequences resulting from excess intake were also reported, including gastrointestinal symptoms, headaches, fatigue, hyperactivity, and chronic disease. Perceived physical, cognitive, emotional, and interpersonal benefits encourage sugary drink consumption and exacerbate well-described challenges of sugary drink reduction, including their palatability, accessibility, and affordability. Findings also suggest that incorporation of strategies to enhance physical, cognitive, and emotional health may hold promise in reducing sugary drink consumption among children and adolescents.

Parental Concerns about Child and Adolescent Caffeinated Sugar-Sweetened Beverage Intake and Perceived Barriers to Reducing Consumption

Sugar-sweetened beverage (SSB) consumption contributes to obesity and chronic disease. SSB intake in children and adolescents remains well above recommendations and reducing intake is challenging. In addition to high sugar content, SSBs are the predominant source of caffeine among youth. However, whether caffeine in SSBs presents unique barriers to reducing consumption is unknown. Herein, we examine parental concerns about child caffeinated-SSB (CSSB) intake and describe parent-reported barriers to lowering their child’s consumption. In-depth qualitative interviews were conducted with 21 parents of children and adolescents 8–17 years of age. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded using Nvivo™, and key themes were identified. Most parents expressed concern about child CSSB consumption, primarily with regard to dietary (e.g., excess sugar), health (e.g., obesity, diabetes) and/or behavioral (e.g., hyperactivity) consequences of frequent intake. Several key barriers to CSSB restriction were reported, encompassing six emergent themes: widespread availability and accessibility; child non-compliance when asked not to drink CSSBs; peer and cultural influences; negative child response to CSSB restriction; family eating behaviors; and, child preferences for CSSBs versus other beverages. Consideration of these barriers, along with the development of novel approaches to address these challenges, will likely bolster success in interventions aimed at reducing CSSB intake among children and adolescents.

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.

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.

A review of caffeine use as a risk or protective factor for women's health and pregnancy

PURPOSE OF REVIEW

To provide a narrative synthesis of recently published studies on caffeine use as a risk or protective factor for health outcomes, with a focus on women's health and pregnancy.

RECENT FINDINGS

Based on predominantly observational studies, moderate caffeine intake has been shown to be a protective factor for liver cancer, certain bowel conditions, colorectal cancer, skin cancer, and regular menstrual cycle function. However, heavy consumption is a risk factor for osteoporosis, urinary incontinence, and poorer birth and child developmental outcomes. Residual confounding and issues surrounding retrospective self-reported intake are cited as key limitations in the majority of these studies. Moderate caffeine intake has been associated with lower risk of cardiovascular disease and metabolic syndrome; however, recent genetic epidemiology studies provide no evidence for a causal relationship.

SUMMARY

Greater inclusion of female participants in studies, and analysis of sex differences in the relationship between caffeine intake and certain health conditions, is necessary. The current literature suggests caffeine's role as a risk or protective factor differs across health conditions. Often, there are plausible biological mechanisms for this relationship. However, a continued precautionary stance is recommended until direct causal pathways are established. Review of recently published studies does not suggest that current intake guidelines for adults and for pregnant woman need to be modified.

Is khat use disorder a valid diagnostic entity?

AIMS

This study aimed to validate the presence of a khat use disorder syndrome using DSM-5 criteria and to examine its relationship with increased experience of harms.

DESIGN

Cross-sectional, purposive sample of current khat-chewers, recruited from khat markets and cafes.

SETTING

Participants were recruited from the general community and from Adama Science and Technology University in Ethiopia.

PARTICIPANTS

A total of 400 current khat consumers aged 16 and above were recruited between September 2014 and January 2015 MEASURES: Survey comprising current clinical symptoms (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV), and validated measures of health, psychological distress, quality of life and academic functioning.

FINDINGS

A third [35.5% 95% confidence interval (CI) = 31.0-40.3] of respondents reported daily khat use and a quarter (25.4% 95% CI = 21.4-30.0) using three times or more per week. Using DSM-5 criteria, 10.5% (95% CI = 7.9-13.9) were categorized as experiencing mild, 8.8% (95% CI = 6.4-12.0) moderate and 54.5% (95% CI = 49.6-59.3) severe khat use disorder. Confirmatory factor analysis demonstrated a good fit of symptoms to a single underlying construct, consistent with other substance use disorders. Individuals categorized as experiencing khat use disorder demonstrated significantly greater frequency [odds ratio (OR) = 45.29; 95% CI = 10.97-19.01) and quantity of khat use (OR = 2.35; 95% CI = 1.29-4.29). They also demonstrated increased financial problems associated with use, greater problems with academic functioning and higher rates of self-reported mental health problems, higher psychological distress and poorer quality of life. Treatment access was poor, with only one-third (32.9%) of individuals with khat use disorder reporting life-time access, near-exclusively related to help-seeking from friends and relatives.

CONCLUSION

The construct of a substance use disorder syndrome for khat using DSM-5 criteria appears valid and performs in a manner consistent with other substances of dependence. Individuals with khat use disorder experience substantial problems in association with khat use. Despite this, there are low levels of help-seeking for these problems.

Evaluating the Validity of Caffeine Use Disorder

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.

Review of the energy drink literature from 2013: findings continue to support most risk from mixing with alcohol

PURPOSE OF REVIEW

In the field of caffeine research, interest in and concern for energy drink consumption have grown. Most caffeine-related research studies published in 2013 focused on energy drink consumption. This article reviews this literature.

RECENT FINDINGS

Prevalence of energy drink consumption varies by measure and age group. Lack of a standardized definition of use inhibits comparison across studies. Studies reviewed show that energy drink consumption is generally low, but the minority who drink the most may be consuming at unsafe levels. Energy drinks are popular among adolescents and young adults. They boost energy and alertness in some conditions, but may have adverse hemodynamic effects. Harmful consequences, including involvement in risky driving, riding with an intoxicated driver and being taken advantage of sexually, were reported significantly more often by adolescents and young adults who combined energy drinks with alcohol compared with those who did not.

SUMMARY

This review of recent literature focused on prevalence, motivation, and consequences of energy drink use. Clear findings emerged only on the dangers of mixing alcohol and energy drinks. The lack of a standardized measure made the comparison across studies difficult. Future research should extend and clarify these findings using standardized measures of use.

Caffeine Use Disorder: A Review of the Evidence and Future Implications

The latest edition of the Diagnostic and Statistical Manual (DSM-5) has introduced new provisions for caffeine-related disorders. Caffeine Withdrawal is now an officially recognized diagnosis, and criteria for caffeine use disorder have been proposed for additional study. caffeine use disorder is intended to be characterized by cognitive, behavioral, and physiological symptoms indicative of caffeine use despite significant caffeine-related problems, similar to other Substance Use Disorders. However, since nonproblematic caffeine use is so common and widespread, it may be difficult for some health professionals to accept that caffeine use can result in the same types of pathological behaviors caused by alcohol, cocaine, opiates, or other drugs of abuse. Yet there is evidence that some individuals are psychologically and physiologically dependent on caffeine, although the prevalence and severity of these problems is unknown. This article reviews the recent changes to the DSM, the concerns regarding these changes, and some potential impacts these changes could have on caffeine consumers.

Caffeine Use Disorder: A Comprehensive Review and Research Agenda

Caffeine is the most commonly used drug in the world. Although consumption of low to moderate doses of caffeine is generally safe, an increasing number of clinical studies are showing that some caffeine users become dependent on the drug and are unable to reduce consumption despite knowledge of recurrent health problems associated with continued use. Thus, the World Health Organization and some health care professionals recognize caffeine dependence as a clinical disorder. In this comprehensive literature review, we summarize published research on the biological evidence for caffeine dependence; we provide a systematic review of the prevalence of caffeine dependence and rates of endorsement of clinically meaningful indicators of distress and functional impairment among habitual caffeine users; we discuss the diagnostic criteria for Caffeine Use Disorder-a condition for further study included in the Diagnostic and Statistical Manual of Mental Disorders (5^th ed.); and we outline a research agenda to help guide future clinical, epidemiological, and genetic investigations of caffeine dependence. Numerous controlled laboratory investigations reviewed in this article show that caffeine produces behavioral and physiological effects similar to other drugs of dependence. Moreover, several recent clinical studies indicate that caffeine dependence is a clinically meaningful disorder that affects a nontrivial proportion of caffeine users. Nevertheless, more research is needed to determine the reliability, validity, and prevalence of this clinically important health problem.

Caffeine Withdrawal and Dependence: A Convenience Survey Among Addiction Professionals

AIMS

Caffeine withdrawal was included in the research appendix of the DSM-IV to encourage additional research to assist with determining its status for the next version of the manual. Caffeine dependence was not included because of a lack of empirical research at the time of publication. This study assessed the beliefs of addiction professionals about the clinical importance of caffeine withdrawal and dependence.

METHODS

A 6-item survey was developed and delivered electronically to the members of six professional organizations that focus on addiction. Open-ended comments were also solicited. Five hundred members responded.

RESULTS

The majority (95%) thought that cessation of caffeine could produce a withdrawal syndrome, and that caffeine withdrawal can have clinical importance (73%); however, only half (48%) thought that caffeine withdrawal should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A majority (58%) believed that some people develop caffeine dependence; however, only 44% indicated that it should be in the DSM. Comments suggested that trepidation about inclusion of caffeine diagnoses was due to the concerns about the field of psychiatry being criticized for including common disorders with a relatively low clinical severity. Others, however, expressed an urgent need to take caffeine-related problems more seriously.

CONCLUSIONS

The majority of addiction professionals believe that caffeine withdrawal and dependence disorders exist and are clinically important; however, these professionals are divided in whether caffeine withdrawal and dependence should be included in DSM. Wider dissemination of the extant literature on caffeine withdrawal and additional research on caffeine dependence will be needed to provide additional guidance to policymakers and healthcare workers.