Elsevier

Drug and Alcohol Dependence

Volume 52, Issue 2, 1 October 1998, Pages 99-107
Drug and Alcohol Dependence

Endorsement of DSM-IV dependence criteria among caffeine users

https://doi.org/10.1016/S0376-8716(98)00083-0Get rights and content

Abstract

The purpose of this article is to determine whether some caffeine users endorse clinical indicators of dependence and abuse. We asked 162 randomly-selected caffeine users generic DSM-IV criteria for dependence, abuse, intoxication and withdrawal pertaining to their caffeine use in the last year via a structured telephone interview. The prevalence of endorsement of dependence items was 56% for strong desire or unsuccessful attempt to stop use, 50% for spending a great deal of time with the drug, 28% for using more than intended, 18% for withdrawal, 14% for using despite knowledge of harm, 8% for tolerance and 1% for foregoing activities to use. Seven percent of users met DSM-IV criteria for caffeine intoxication and, among those who had tried to stop caffeine permanently, 24% met DSM-IV research criteria for caffeine withdrawal. Test-retest interviews for dependency agreed in 29/30 cases (97%). Eight expert substance abuse clinicians agreed with self-endorsed caffeine dependence 91% of the time. Our results replicate earlier work and suggest that a substantial proportion of caffeine users exhibit dependence-like behaviors. Further studies are needed to determine whether such users exhibit a clinically significant syndrome of drug dependence.

Introduction

Caffeine is the most commonly consumed psychoactive drug in the world (Barone and Roberts, 1984). Whether caffeine use can produce abuse or dependence is debatable (Hughes et al., 1992, Heishman and Henningfield, 1994, Griffiths and Mumford, 1995). Although human laboratory data suggest caffeine can produce positive subjective effects, serve as a reliable reinforcer, maintain large amounts of self-administration behavior, and can induce withdrawal, clinical data on caffeine use disorders are restricted to anecdotal reports (Adams et al., 1993). The one exception is a case series (Strain et al., 1994) that clearly documented some caffeine users exhibit dependence phenomena. The purpose of the present study was to examine whether many caffeine users in the general population would endorse dependence behaviors.

The study focuses on the generic drug dependence and drug abuse definitions in the two most widely used diagnostic systems, i.e. the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) (American Psychiatric Association, 1994) and the World Health Organization's International Classification of Disorders (ICD-10) (World Health Organization, 1992). Caffeine dependence and abuse are not currently included in DSM-IV due to a paucity of clinical evidence on caffeine dependence and abuse (Hughes, 1994). The WHO's ICD 10 (World Health Organization, 1992) uses similar generic criteria for dependence and abuse (the latter termed `harmful use') to DSM-IV. In ICD-10, dependence and abuse could be diagnosed for caffeine under `mental and behavioral disorders due to use of other (i.e. noncocaine) stimulants, including caffeine'. Caffeine intoxication is included in DSM-IV and includes symptoms such as agitation and tremors. Caffeine withdrawal is not included in DSM-IV as an accepted disorder but is included as a `disorder worthy of further study'.

Our study was part of the DSM-IV field trials on substance use disorders (Cottler et al., 1995) and consisted of structured telephone interviews to see if randomly selected caffeine users would endorse DSM-IV and ICD-10 criteria for substance use disorders when applied to their caffeine use. The study also examined the test-retest reliability and estimated the clinical validity of such self-endorsements.

Section snippets

Participants

In the fall of 1990, we recruited 202 adults with a random-digit dial telephone survey of the Chittenden County VT metropolitan area. In the 1990 Census, 66% of Chittenden county residents lived in an urban area. Numbers to be called were determined by the method of Waksberg (Waksberg, 1978) and one adult per household was selected by the method of Kish (1965). The only exclusion criteria were age (<18) and incomplete data (six participants). Participants completed a brief verbal informed

Response rate and subject characteristics

Among individuals contacted, 51% completed the interview. This relatively low rate was probably due, in part, to local media reports of telephone pranksters pretending to be University of Vermont surveyors asking sexual histories. These reports occurred in the first week of our survey.

The caffeine intake of our sample is presented in detail in another paper (Hughes and Oliveto, 1997). Briefly, 96% of participants reported ever using, 83% currently using and 14% previously using a caffeinated

Discussion

Our main finding is that a substantial number of current coffee, tea and soda drinkers endorse criteria for dependence, withdrawal or intoxication as applied to their caffeine use. Before discussing the implications of this result, several methodological issues deserve comment.

First, unlike most epidemiological and nosological studies of drug dependence, our interview was conducted over the phone. Our pilot work indicated no difference in rates of endorsement of criteria for phone versus

Implications

Our finding that a significant number of caffeine users endorse dependence criteria raises two interesting questions. First, debates about the recognition of new drug dependencies often focus on the severity or clinical significance of the drug dependence being examined, especially in relation to known drugs of dependence (Robinson and Pritchard, 1992Hughes, 1993Heishman and Henningfield, 1994). Typically, demonstration that there is a substantial cache of persons with a severe form of the drug

Acknowledgements

This study was supported by grants DA-04843, Institutional Training Grant DA-0742 (AO) and Research Scientist Development Award DA-00109 (JRH) from the National Institute on Drug Abuse and grant MH17104 from the National Institute on Mental Health. We thank Drs Thomas Babor, Linda Cottler, John Helzer, Thomas McLellan, Peter Nathan, Edward Nunes, William Weddington, and Donald Wesson for reviewing the case reports.

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