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Running on caffeine

November 29, 2010
by Kim Lane
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Clinicians need to be aware of issues that could signal caffeine dependence

Move over, addictive substances, to make room for America’s number one consumed substance: caffeine. It is estimated that 80 to 90% of Americans consume caffeinated products daily.1,2 Coffee is the caffeinated beverage of choice for most adults, but caffeine is not just the choice of adults anymore. Soda products and energy drinks have become a popular option among young adults and children.

In fact, children, adolescents and young adults are consuming a colossal amount of caffeine in their daily diet. The lucrative business of promoting energy drinks is paving the way for additional sources of higher-potency caffeine in the form of infused snacks. Poison control centers are seeing increases in calls regarding caffeine poisoning.

While caffeine has become specifically sought after by children and adults, we also should be mindful of other substances that are linked to energy boosting (cocoa, kola nut, guarana, yerba root, etc.). Using these ingredients in combination in various products increases the overall potency.

Caffeine has several positive attributes if consumed at a recommended rate. It can lead to a more rapid, clearer flow of thoughts, and it can yield a greater sustained intellectual effort.
3,4 When consumed at a higher rate than advised, however, it may cause sleeping troubles, irritability, restlessness, heart palpitations, muscle and body tremors, anxiety, and headaches. It is critical that people monitor the specific types of beverages they consume throughout the day, given the cumulative effect of caffeinated products on the kidneys and liver. Negative physical symptoms often are masked to resemble other medical conditions, and are treated as such.

Once an energy drink or coffee is consumed in a given day, a second caffeinated beverage might put a person at risk of caffeine intoxication. The National Institutes of Health (NIH) reports symptoms of caffeine poisoning as including trouble breathing and diarrhea.
5,6 When does average consumption lead to negative symptoms? The revised version of the DSM-IV states that 250 mg may cause caffeine intoxication. The manual lists symptoms of caffeine intoxication as restlessness, nervousness, excitement, insomnia, muscle twitching, flushing, agitation, heartbeat dysfunction, and rambling thoughts. Such symptoms mirror symptoms of generalized anxiety, attention-deficit/hyperactivity disorder (ADHD) and other disorders.

Since the symptoms might mirror those of other diagnoses, it is imperative to be thorough in assessing and reassessing a person’s caffeine intake. Assessing for caffeine intake often requires an educational component that might include stating the purpose for specific questions about food and beverage choices and when in the day they occur. Frequently, consumers will find the line of questioning intrusive. Because there is a fairly substantial difference between consuming a cup of coffee and consuming a potent energy drink, assessments should include collecting information on what particular brands of products are being used, how often, and when. An additional area of interest concerns the user’s situation or emotional state driving the consumption.
Assessment considerations
Creating a routine for assessing for consumption of caffeinated products is essential. When devising a diagnosis, an assessment of physical ailments and quality and quantity of sleep should be completed. Among physical concerns with the consumption of caffeine is a decreased level of calcium absorption in the body. Such an alarm might lead to the need to collaborate with a person’s medical provider to assist with sorting through the pain.

Whenever diagnosing a person, a provider must consider the whole person. It is not enough to look specifically at the reason the person stated for originally entering treatment. It is critical to rule in or out any medical condition that may affect the success of treatment prior to diagnosing. Providers must view symptoms from both the emotional and physical level, with the latter involving consultation with a physician. It is essential to continue the assessment of caffeine consumption throughout treatment, as treatment adherence poses a challenge for consumers given their desire for alertness and need for energy (in a society that wants more from us for less). A provider might want to consider caffeine consumption within the substance use continuum that includes use, abuse, and addiction/dependence. Recommended daily use is no more than 250 mg. Abuse may be occasional or regular, but the person will begin to experience negative symptoms. Dependence is present when the consumption is progressive, when there is a preoccupation with desire and a sense of loss of control, and when a person has experienced unrelenting negative consequences. The provider will need to determine where the person belongs on the substance use continuum. Diagnosis and treatment will follow accordingly.