Caffeine Withdrawal and Dependence: A Convenience Survey Among Addiction Professionals

Translation and validation of the caffeine use disorder questionnaire in Arabic

BACKGROUND

Due to the elevated global prevalence of its consumption, and the detrimental health effects it can have, caffeine use disorder (CUD) should receive a great deal of attention from clinicians and the research community in Arab countries as an area of concern. To help advance the field, this study aimed to translate the Caffeine Use Disorder Questionnaire (CUDQ) into the Arabic language, and examine its psychometric properties in community adults.

METHODS

A descriptive, observational and cross-sectional study was carried out during the period from May to July 2024. Arabic-speaking adults from the general population of Lebanon (N = 1858, 49.8% males, mean age of 30.05 ± 11.39 years), reporting caffeine consumption at least once during the last 12 months, were included.

RESULTS

The study's results provided support to the theoretical assumptions of unidimensionality of the original version of the CUDQ, with excellent composite reliability (Cronbach's α = 0.90). Furthermore, the structure of the Arabic CUDQ was equivalent across sex, suggesting that the latent CUD construct has the same meaning in male and female adults. The highest CUDQ scores were reported by participants drinking 7 to 9 cups and 10 cups or more of coffee/per day relative to those consuming lower amounts of coffee. Finally, our findings revealed good concurrent validity based on positive correlations of CUDQ scores with nicotine dependence, depression and anxiety scores.

CONCLUSION

Overall, findings suggest that the CUDQ is appropriate and suitable for use to measure CUD among Arabic-speaking adults from the general population. Making the CUDQ available in the Arabic language can fill a gap in the assessment of problematic caffeine consumption in Arab contexts. Future studies are required to further confirm the psychometric soundness of the Arabic CUDQ in more representative samples, specific populations and other Arab countries.

The Effects of Caffeine on Blood Platelets and the Cardiovascular System through Adenosine Receptors

Caffeine is the most popular and widely consumed behaviourally active substance in the world. This review describes the influence of caffeine on the cardiovascular system, with a special focus on blood platelets. For many years, caffeine was thought to have a negative effect on the cardiovascular system mainly due to increasing blood pressure. However, more recent data suggest that habitual caffeine consumption may reduce the risk of cardiovascular disease and hypertension. This could be a significant finding as cardiovascular disease is the leading cause of death worldwide. Caffeine is known to inhibit A1 adenosine receptors, through which it is believed to modulate inter alia coronary blood flow, total peripheral resistance, diuresis, and heart rate. It has been shown that coffee possesses antiplatelet activity, but depending on the dose and the term of its use, caffeine may stimulate or inhibit platelet reactivity. Also, chronic exposure to caffeine may sensitize or upregulate the adenosine receptors in platelets causing increased cAMP accumulation and anti-aggregatory effects and decrease calcium levels elicited by AR agonists. The search for new, selective, and safe AR agonists is one of the new strategies for improving antiplatelet therapy involving targeting multiple pathways of platelet activation. Therefore, this review examines the AR-dependent impact of caffeine on blood platelets in the presence of adenosine receptor agonists.

Development and initial psychometric validation of the Brief-Caffeine Expectancy Questionnaire (B-CaffEQ)

Caffeine is the most widely available and consumed psychoactive substance in the United States. Extant work indicates that across substances, use expectancies play a marked role in the development and maintenance of consumption patterns. Despite a burgeoning line of etiological and intervention-oriented research focused on expectancies (e.g., alcohol), there is a limited literature regarding caffeine use effect expectancies, specifically. To facilitate this work, the Caffeine Expectancy Questionnaire (CaffEQ) was developed and psychometrically validated; however, the length of the CaffEQ (i.e., 47 items) may hinder widespread adoption of this tool. As such, the current study provides an initial psychometric validation of a brief, 20-item version-the Brief-Caffeine Expectancy Questionnaire (B-CaffEQ)-in a multiethnic sample of undergraduate students (N = 975). Results showed that the B-CaffEQ replicated the 7-factor structure of the original CaffEQ using both constrained (confirmatory factor analysis) and less constrained (exploratory structural equation modeling) structural models and evidenced good internal consistency across subscales. The B-CaffEQ also demonstrated concurrent validity with caffeine use frequency indices, replicated and extended convergent validity between caffeine expectancy subscales and related behavioral and psychological constructs, and demonstrated discriminant validity with other related, but notably distinct, stimulant use metrics (e.g., cocaine, Ritalin). Lastly, the B-CaffEQ appears to provide an invariant measure of expectancies across types of caffeine users. These findings indicate that the B-CaffEQ is a reliable assessment of caffeine use effect expectancies, with acceptable-to-good psychometric properties-comparable in length to other substance use expectancies measures-that may be more readily incorporated into research and clinical settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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.

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.

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.

Caffeine addiction? Caffeine for youth? Time to act!

While data accumulate and discussion evolves on the clinical importance of caffeine addiction and its classification, the growing practices of (i) adding increasing amounts of caffeine to drinks and other consumables, (ii) promoting these as performance enhancers and (iii) targeting youth as the consumer raise concerns that require immediate action.

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.