Caffeine Withdrawal DSM-5 292.0 (F15.93)
DSM-5 Category: Substance-Related and Addictive Disorders
Because 90% of adults and 85% of children in the United States drink the equivalent of 7 soft drinks worth of caffeine each day, caffeine dependence and withdrawal are extremely common. The DSM-5 describes caffeine withdrawal as any withdrawal syndrome that occurs after abrupt cessation of caffeine intake. Common symptoms of caffeine withdrawal include headache, anxiety, depression and low energy. Other symptoms include difficulty concentrating, fatigue, nausea and flu-like symptoms. Although caffeine dependence is extremely common, heritability may account for as many as three quarters of all caffeine addictions. The most common reason for caffeine withdrawal is the recommendation of a doctor or desire to improve health. Because caffeine withdrawal symptoms are benign, if uncomfortable, treatment is relatively easy and accessible without formal interventions.
Symptoms of Caffeine Withdrawal
Symptoms of caffeine withdrawal have been described since the early nineteenth century but have only recently been researched (Ozsungur, Brenn & El-Sohemy, 2009) . The DSM-5 explains that the most common symptom of caffeine withdrawal is headache. The headache is usually throbbing and sensitive to movement. Headache is the most persistent symptom of caffeine withdrawal and can last as long as three weeks. Changes in mood, such as depression and anxiety; difficulty concentrating and fatigue are also common and can occur without headache. Some patients experience flu-like symptoms such as nausea, vomiting and achiness (American Psychiatric Association, 2013). Other symptoms include caffeine cravings and increased appetite (Juliano, et al., 2012) These symptoms begin within 12- 24 hours of caffeine cessation after prolonged daily caffeine ingestion (American Psychiatric Association, 2013). 96% of patients experience at least two symptoms during withdrawal (Juliana, et al., 2012) Symptoms often occur on weekends when individuals tend to sleep in and begin ingesting caffeine later in the day than normal. If caffeine cessation continues, symptoms can last as long as nine days, with headaches lasting as long as three weeks. Symptoms disappear almost instantly if caffeine consumption resumes. Because many people underestimate their caffeine consumption, symptoms are often unexpected and attributed to other causes, such as illness (American Psychiatric Association, 2013).
Caffeine Tolerance and Addiction
90% of adults and 85% of children in North America consume caffeine on a regular basis. The average intake is 280 milligrams a day ( Ozsungur, Brenn & El-Sohemy, 2009).This is equal to two cups of coffee or seven soft drinks (Juliano, et al., 2012. Because regular use of caffeine results in tolerance, many people increase daily intake hoping to experience its effects. Additionally, chronic caffeine intake results in dependence. Many people maintain or increase caffeine consumption to avoid the symptoms of caffeine withdrawal (Ozsungur, Brenn & El-Sohemy, 2009). Most people who use caffeine regularly report that it increases alertness, energy and performance. Many people deliberately incorporate caffeine into to their daily routines. For example, many people feel as though they are unable to begin their day without a cup of coffee. Unfortunately, caffeine also lowers the quality and quantity of sleep. Because of this, many people reduce or stop caffeine consumption (Lack & Johannson, 2013).
Genetic Influence on Caffeine Withdrawal Symptoms
Several studies have found a genetic influence on caffeine addiction. Twin studies have found that the heritability of caffeine dependence is about 43% for moderate user and 77% for heavy caffeine users. Similarly, genetics influence the ways that an individual responds to caffeine withdrawal. The heritability of specific withdrawal symptoms is 34% (Palmer, Paler & Wit, 2010).
Anxiety and depression are the most common disorder comorbid with caffeine withdrawal. Tobacco use is also common. Less than 3% of patients experiencing caffeine withdrawal have a history of dependence on illicit drugs such as marijuana, cocaine or heroin (Juliano, et al, 2012).
Social Consequences of Caffeine Withdrawal
The DSM-5 explains that caffeine cessation can be a difficult experience because caffeine use is a part of common social functions and daily rituals. Many people enjoy the ritualistic aspect of enjoying a cup of coffee in the morning or enjoying a soft drink with lunch. Coffee and other caffeinated drinks are often served and enjoyed at social events. In addition to the social nature of caffeine, symptoms of caffeine withdrawal can also create social and functional impairment. Severe headaches and other symptoms related to caffeine withdrawal can make patients feel extremely ill. This of course can result in missed school or work and cancelling social engagements (American Psychiatric Association, 2013).
Treatment of Caffeine Withdrawal
The most common reasons people try to reduce or stop caffeine use are for health or desire to not be dependent on caffeine. In many cases, a medical doctor will suggest reducing or stopping caffeine consumption to address a specific health concerns. The most common health conditions that relate to caffeine reduction or cessation include pregnancy, cardiovascular problems, gastrointestinal problems, bladder problems, dental health, anxiety, and weight concerns (Juliano, et al., 2012).
Because the duration of caffeine withdrawal is short, and because the symptoms are benign, formal treatment is not necessary or often recommended for caffeine withdrawal. If caffeine abstinence is unintentional, consumption of caffeine can relieve withdrawal symptoms within thirty minutes. If abstinence is intended, which is common to address certain medical conditions, pregnancy or a desire to break addiction, the symptoms typically resolve themselves shortly. Still, there are some measures individuals can take to reduce the severity of symptoms.
Low intensity yoga, for example can address withdrawal symptoms such as fatigue and muscle pain. Some yoga positions can also relieve headaches associated with caffeine withdrawal. Yoga can also relieve tension, allowing an individual to overcome caffeine addiction (Bjorkegren, 2011). A breathing technique that originates in yoga practice is also useful in managing uncomfortable caffeine withdrawal symptoms. Right nostril breath involves pinching the nose so that the patient only breathes from the right nostril. This practice increases oxygen, blood pressure and blood glucose. This creates a naturally stimulating effect, similar to that of caffeine ingestion (Kollak, 2013).
If an individual plans to reduce or cease caffeine intake before symptoms of caffeine withdrawal begin, withdrawal symptoms can be avoided. The most effective method of avoiding caffeine withdrawal is to reduce caffeine consumption slowly. This can be done by replacing caffeinated food or drinks with other foods or drinks. If done slowly, the individual’s body will adjust to the new levels of caffeine consumption without uncomfortable withdrawal symptoms (Lack & Johannson, 2013).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bjorkegren, K. (2011) Yoga for Women : Gain Strength and Flexibility, Ease PMS Symptoms, Relieve Stress, Stay Fit Through Pregnancy, Age Gracefully. New York: Skyhorse Publishing, Inc.
Juliano, L.M., Evatt, D.P., Richards, B.D. & Griffiths, R.R. (2012). Characterization of individuals seeking treatment for caffeine dependence. Psychology of Addictive Behaviors. 26 (4) : 948-954
Kollak, I. (2013) Yoga XXL : a Journey to Health for Bigger People. New York : Demos Medical Publishing.
Lack, L. & Johannson, K. (2013). Caffeine withdrawal: Cost or benefit? Sleep Medicine, 14(1): 53
Ozsunger, S., Brenner, D. & El-Sohemy, A. (2009). Fourteen well-described caffeine withdrawal symptoms factor into three clusters. Psychopharmacology, 201(4): 541-548
Palmer, A.A., Palmer, A. & Wit, H. (2010). Genetics of caffeine consumption and responses to caffeine. Psychopharmacology, 211( 3): 245-257
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