Are You Addicted To Coffee?

Are You Addicted To Coffee?

With pumpkin-spice latte season in full swing, many Americans may be finding themselves waiting in line for coffee more than usual. While a cup of joe undoubtedly can give a jolt of focus to a fuzzy morning, it also has real side effects. Caffeine use disorder was added to the most recent edition of “The Diagnostic and Statistical Manual of Mental Disorders” as a condition for further study, and caffeine is the most-used drug in the world. What are the signs that you’re addicted, and how can you kick the habit? One expert, Laura Juliano, a psychology professor at American University who specializes in addiction, spills the beans.

When you ingest caffeine, it occupies the brain’s adenosine receptors, whose job is to tell the body it’s sleepy. By blocking that neuromodulator, the caffeine makes you feel alert. There is also evidence that caffeine stimulates the reward center of the brain. “So the brain says, ‘This feels good. How can I do this again?’ ” Dr. Juliano says. Because your body has made adjustments to adenosine production, when the caffeine is taken away or wears off, you may experience fatigue, headaches, mood disturbances, even nausea. This is physical addiction in a nutshell: The body has adjusted for the drug, requiring increasingly more of it to get that buzz and stave off withdrawal symptoms. “Regular users will choose to take caffeine over money, over a placebo—so it shares the same reinforcing qualities that we see in other recreational drugs,” Dr. Juliano says. That in itself isn’t necessarily a problem. She is more concerned with psychological addiction, also referred to as caffeine use disorder in the DSM, when a person is physically dependent and uses the drug to avoid withdrawal, has tried to quit but cannot, and continues to use caffeine despite physical or psychological problems. One example, she says, would be using caffeine despite having trouble sleeping.

Many people don’t know they are physically dependent until they stop consuming their go-to energy drink or macchiato on vacation or before a medical procedure. “Since caffeine is embedded in our routines and social customs, people can go 20 years without missing a day and they don’t know they are dependent,” says Dr. Juliano, who treats caffeine and tobacco addicts. “One of my patients was drinking 20 cups of coffee a day and experiencing a great deal of anxiety until he cut back,” she says. Clear signs of withdrawal are headaches, tiredness and aches, but she’s seen worse. “Sometimes people get caught off-guard, and they think they have the flu, or the worst headache of their life.” She has even heard of someone who thought he was having a brain aneurysm.

While studies have shown that as little as 100 mg of caffeine a day can result in physical dependence, Dr. Juliano believes that having less than 400 milligrams of caffeine day should be fine for most healthy adults, unless they are pregnant or have certain medical issues. A typical 12 oz. serving of drip coffee has anywhere from 107 mg to 420 mg, she says. For the big energy drinker who wants to cut back, she recommends a slow wean, not cold turkey. That is because if you just quit, Days Two and Three can be a misery of withdrawal, and can even include vomiting and nausea. “But it’s temporary,” Dr. Juliano says. “Most people are past the worst withdrawal symptoms three days after the last dose. After nine days, it should resolve.” To avoid the worst, “We suggest you cut your caffeine consumption in half each week,” she says. In a month, the withdrawal should be more tolerable. She continues to work with patients to keep them off anxiety-inducing caffeine, since preventing a relapse can be harder than quitting.

Dr. Juliano herself drinks coffee daily, just like more than 50% of Americans, according to the National Coffee Association. She doesn’t think most people have a psychological addiction, but she does offer a checklist to see if going without caffeine is worth the pain of withdrawal. She suggests checking in regularly with yourself, asking how your general health is, how you’re sleeping and how your anxiety levels are. “In our society, we have many people who suffer from anxiety and sleep problems, and they should consider giving themselves some relief from caffeine and seeing if that helps,” she says. Added bonus: all that money saved on cappuccinos and energy drinks.

Credit: Heidi Mitchell for The Wall Street Journal 30 October 2017