Am J Psychiatry 1992; 149:33-40
Copyright © 1992 by American Psychiatric Association
Should caffeine abuse, dependence, or withdrawal be added to DSM-IV and ICD-10?
JR Hughes, AH Oliveto, JE Helzer, ST Higgins and WK Bickel
Department of Psychiatry, University of Vermont, Burlington 05401.
OBJECTIVE: The authors reviewed basic science and clinical data on caffeine
abuse, dependence, and withdrawal in order to make a conclusion about
whether these disorders exist and should be included in DSM-IV and ICD-10.
METHOD: Studies were located through computerized searches, reference
sections of published articles, and written requests. RESULTS: The studies
show that abstinence from caffeine induces a withdrawal syndrome of
headache, fatigue, and drowsiness which begins within 12-24 hours and lasts
about 1 week. The syndrome can be severe and appears to be one reason for
continued use of coffee. The prevalence of this caffeine withdrawal
syndrome is unknown. Use of caffeine may aggravate some common behavioral
and medical disorders. In double-blind tests, a subset of coffee and soda
drinkers reliably self- administered caffeinated beverages in preference to
uncaffeinated beverages. Clinical indicators of dependence, such as
difficulty stopping use of caffeine and use despite harm, have not been
documented. CONCLUSIONS: Caffeine withdrawal but not caffeine abuse or
dependence should be included as a diagnosis in DSM-IV and ICD-10. Future
research should focus on whether some caffeine users exhibit clinical
indicators of drug dependence.
