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Yes, People Are Right. Caffeine Is Addictive. By SANDRA BLAKESLEE Published: October 5, 1994
RESEARCHERS have confirmed for the first time the widely held belief that some people are addicted to caffeine in the same way that others are addicted to cigarettes, alcohol or intravenous drugs.
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Caffeine addicts may try to give up their coffee, tea or cola habit but usually cannot, even when it threatens their health. Like emphysema patients who continue smoking cigarettes, they continue to use caffeine against their doctors' orders.
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The study on caffeine dependence appears in today's issue of The Journal of the American Medical Association. The research, sponsored by the National Institute on Drug Abuse, was done by Dr. Roland Griffiths and Dr. Eric Strain in the department of psychiatry and behavior sciences at the Johns Hopkins School of Medicine in Baltimore.
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Dr. Richard M. Glass, the journal's deputy editor, said the study "is important in that caffeine is so widely used and in showing that some people have this dependence on it."
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But Dr. Glass added: "I am concerned that the tobacco industry may try to use the study to trivialize the concept of nicotine addiction. If coffee and Twinkies can be addictive, why worry about cigarettes?"
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The researchers also stressed that the finding should not be misconstrued to diminish the dangers of smoking, alcohol and illicit drug use. Misuse of alcohol accounts for 100,000 deaths a year, and smoking is implicated in another 400,000 premature deaths each year in the United States. By comparison, they say, caffeine is extremely benign.
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"Caffeine is the world's most widely used mind-altering drug," Dr. Griffiths said. People consume it in many forms, including coffee, tea, sodas, mate, kola nuts and as tablets to stay awake while driving. In this country, he said, more than 80 percent of adults use caffeine, consuming an average of 280 milligrams a day, which is a little more than the amount found in about two cups of coffee.
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In most people, he said, this amount of caffeine produces a mild, positive effect, including a feeling of well-being and alertness. Higher doses can produce anxiety and nervousness, but those negative effects do not in themselves constitute serious health risks, he said.
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"People talk about being addicted to coffee or soda," Dr. Griffiths said, but he noted that there had been little clinical evidence that people could not quit if they chose to. "We know from laboratory studies that people can get physically dependent on caffeine and show tolerance to it, but that doesn't mean they have great difficulty giving it up." To measure addiction, the researchers used the American Psychiatric Association's definition of drug dependence. They looked at four criteria: withdrawal symptoms, development of tolerance over time to the effects, use of the substance in spite of aggravation of medical or mental problems, repeated unsuccessful attempts at quitting.
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To be physically and psychologically addicted to caffeine, a person needs to meet all four criteria, Dr. Griffiths said. Many coffee, tea and cola lovers are physically dependent on caffeine, he said, and will suffer temporary headaches, lethargy and depression when they stop using it. But of the millions of Americans who like and use caffeine, he said, only a small but as yet unknown percentage are true addicts. To find caffeine addicts, the researchers put an advertisement in a local newspaper asking for volunteers who thought they were hopelessly dependent on caffeine. After a series of telephone and written psychiatric interviews, the researchers identified 16 people who met all the criteria of caffeine addiction. Of these, 11 agreed to participate in a controlled experiment. Some of the people routinely consumed less caffeine than is found in a single cup of coffee, while one person drank the equivalent of 25 cups of coffee a day, Dr. Griffiths said. But people excrete caffeine at widely different rates, which means that a seemingly small dose can have large effects in some people, he said. Thus, daily caffeine intake is not a leading factor in determining who is addicted. To eliminate the possibility that caffeine addiction is imaginary, the subjects were not told that the experiment was a caffeine study, Dr. Griffiths said. Rather they were told that the researchers' goal was to examine the effects on mood and behavior of several compounds normally found in food and beverages. Accordingly, they were asked to avoid a variety of specific foods and drinks for two days. During this time, the subjects were given pills said to contain one of several compounds commonly found in those foods. Some people got dummy pills containing simple starch. Others got pills containing the exact amount of caffeine that it was known they habitually consume each day, based on food diaries they had filled out. Half the subjects were coffee drinkers and half were cola lovers. Only one was a tea drinker. All reported having great difficulty giving up caffeine, despite worries that it was harming their health. Of those getting the dummy pill, most were functionally impaired for a day and a half. One person who had a manufacturing job made costly errors. Another could not bring herself to go to work. Another spent the afternoon in a dark office with her head on her desk. One woman called off her child's birthday party. Most went to bed early, Dr. Griffiths said. Dr. Griffiths described the extremes to which people might go to obtain caffeine products, he said. One pregnant woman in the study who had avoided caffeine during her pregnancy, recalled going into labor and asking her husband to stock up on caffeinated soda so she could have it when she got home from the hospital. When he refused, she went to the store herself while in labor to buy the sodas. Dr. Griffiths said one implication of the study was that caffeine was a drug that should be given respect. The study suggests that it may be more difficult to give up caffeine than most people think. As for how to stop using caffeine, Dr. Griffiths suggested that people should taper off gradually. Drawing.
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