Coffee is our national drink and its popularity only appears to be growing. A staggering 400 million cups of our favorite beverage are enjoyed daily in America alone. Indeed, recent research has been highly positive in vindicating coffee drinking as a health-promoting habit. Regular consumption appears to help combat chronic conditions like type 2 diabetes and liver disease. Of course, our choice of additives (including sugar) has a significant influence on the overall balance of coffee’s positive and negative effects.
Nevertheless, a frequently asked question among regular coffee drinkers remains — “is coffee truly addictive?” We’ve all experienced a morning or two in which we’ve been unable to grab our early cup of coffee and its absence in our routine can leave us feeling lethargic and even irritable. But are these signs of “withdrawal” in a meaningful sense of the word? Or are they just a normal part of a busy, and perhaps sleep-deprived, life?
What Do Psychiatric Authorities Say?
The American Psychiatric Association publishes a manual known as the Diagnostic and Statistical Manual of Mental Disorders. Currently, in its 5th edition, the DSM serves as the leading authority in mental health diagnoses.
Interestingly, Caffeine Use Disorder has been placed in a special category by the APA referred to as “conditions for further study”. Although this disorder is not yet a specified diagnosis, it does share a place with behavioral addictions like “internet gaming disorder” as an area of meaningful interest to psychiatric professionals.
The inclusion and indeed the recognition of a caffeine-related disorder in the manual at all is a subject of some debate. The DSM’s suggested symptoms for Caffeine Use Disorder are threefold:
- Persistent desire or failed attempts to quit
- Continued use despite “harm”
- Withdrawal symptoms
We can all relate to the persistent desire for our favorite cup, but this alone doesn’t indicate harm. Pathologizing caffeine use would implicate the vast majority of Americans and the benefits of doing so are questionable at best. This is why all three of these symptoms must be present in order for a meaningful diagnosis to be made.
Examining the evidence
In the scientific literature, perhaps the most tenuous of the three criteria is the possibility of harm stemming from “continued use”.
Caffeine intoxication is a genuine concern for the small percentage of coffee drinkers who ingest very sizeable doses of the stimulant. Tolerance building from regular consumption protects heavy drinkers from some of the more intense stimulating effects of caffeine.
However, unaccustomed users can be particularly heavily impacted by symptoms such as dizziness, diarrhea, and irritability. More serious symptoms include chest pain, trouble breathing, and even convulsions.
It’s important to note that the overwhelming majority of Americans consume coffee in low to moderate amounts, albeit in a habitual manner. In this case, the diagnostic criteria of “continued use despite harm” begins to reach a wall of conflicting and inconclusive evidence.
Establishing a safe intake
According to this comprehensive review published in the Journal of Caffeine Research, habitual caffeine users self-identify as continuing their habit despite harm at an alarmingly high rate. When questioned, 14% of the general population believe their use of caffeine qualifies as continuing despite harm. Unsurprisingly, this number skyrockets to 87% among those individuals seeking treatment for caffeine dependence.
A 2017 study published in Frontiers in Psychiatry aimed to review the existing evidence regarding the safety of caffeine. In general, a moderate daily intake of 400mg is not believed to be associated with adverse effects in a number of key areas ranging from cardiovascular health to cancer risk.
However, particular recommendations are highly variable and adolescents, pregnant women, and those with preexisting mental illness are advised to talk to their doctor about appropriate levels of consumption.
The dreaded withdrawal
Anecdotes abound when it comes to chatting about caffeine withdrawal. But to what extent is the experience exaggerated? And how does caffeine withdrawal compare to the effects of withdrawal from other more serious psychoactive substances?
Cold turkey cessation of coffee drinking (and all caffeine consumption) is believed to cause “mild distress” and a noticeable impairment of functioning.
Symptoms can include reduced cognitive performance, fluctuations in blood pressure, and decreased motor activity.
Although relatively mild, these effects are obviously unwelcome and unpleasant. Nevertheless, it’s worth remembering that the symptoms of caffeine withdrawal in most people pale in comparison to the suffering caused by withdrawal from other recreational drugs. Indeed, a carefully managed regimen of careful and slow reduction in coffee consumption can help offset the most significant symptoms of an immediate and total withdrawal.
Caffeine withdrawal, and by extension coffee withdrawal, does exist, but in most individuals, the impairment is mild and fleeting.
The evidence of harm from caffeine is conflicting and low to moderate consumption is very safe for most people.
Cravings are normal and not necessarily indicative of harm.
Individuals suffering from a mental health condition and other groups including pregnant women should consult their doctor to establish an appropriate level of usage.
Keep on enjoying your coffee, and remember the old adage “everything in moderation”!