Nursing News:
Caffeine addiction more pervasive than previously thought

By MICHAEL STROH
Mark Nicholson considers himself a recovered drug addict of sorts. His addiction? ³Coca-Cola,² he says. Or more precisely, the caffeine spike in every can. The 51-year-old Idlewylde, Md., nurse spent years stashing sodas in his car, in his hospital locker, even by his bed. It was frequently the last thing he drank at night, the first when he awoke. If he didnıt get his fix, he paid: ³Iıd get this humongous headache and feel like I was going to throw up.² Nicholson ultimately kicked the caffeine habit with help from a little-known Johns Hopkins Hospital program for people hooked on the drug. But latte lovers, chocoholics and other caffeine junkies take heed: While this particular case may sound extreme, mounting scientific evidence shows that jokes about caffeine withdrawal are no joke at all ‹ and it doesnıt take much to get hooked.
³Some people say itıs all in your head,² says Roland Griffiths, a caffeine researcher at the Johns Hopkins School of Medicine. ³Weıre able to show, based on a number of rigorous studies, that itıs real and biological.² Just a sip lights you up In the most comprehensive survey of caffeine withdrawal research to date, Griffiths and a colleague pored over 170 years of studies and concluded that a habit of drinking just one small cup of coffee ‹ only 100 milligrams of caffeine ‹ is all it takes to trigger withdrawal symptoms that include headaches, fatigue and irritability. For serious caffeine junkies, going cold turkey can be even more traumatic. The latest analysis, published last month in the journal Psychopharmacology, found that some experience flulike symptoms such as muscle pain, nausea and vomiting when they go off caffeine. Thirteen percent of people weathering withdrawal have to call off work or cancel daily chores.
Some psychologists are even pushing the American Psychiatric Association to classify caffeine withdrawal as a bona fide mental disorder in the next edition of its Diagnostic and Statistical Manual of Mental Disorders. If that happens, it will likely be due in part to Griffiths. The 58-year-old psychologist is regarded as one of the countryıs leading investigators of caffeine and its effects. Legal and generally safe, caffeine is the most popular mind-altering drug in the world, consumed by 80 percent of Americans. That fact alone made it worth investigating, says Griffiths, who became interested in the drug in the 1980s.
As a researcher who also studies nicotine, cocaine and other, often-abused drugs, he also realized that caffeine might be a good model for analyzing the addiction process. ³Itıs not cocaine,² Griffiths explains. Yet ³it controls behavior.² Just how much remains hotly debated. The American Psychiatric Association doesnıt recognize caffeine as a drug that causes dependence. But Griffiths says anybody who requires convincing need only hang out at a Starbucks some morning ‹ as Griffiths has done ‹ to watch the regulars roll in like clockwork. ³People get dependent on caffeine,² says Griffiths. ³The question is: How does the drug do that? What kind of biological mechanism is it hijacking? It becomes this really interesting puzzle to figure out whatıs going on.² Once consumed, caffeine acts quickly. ³This means that, soon after you finish your cup of coffee or tea, caffeine will be present in virtually every cell of your body,² Bennett Weinberg and Bonnie Bealer note in ³The World of Caffeine: The Science and Culture of the Worldıs Most Popular Drug.² Griffithsı research has shown that people begin to feel caffeineıs mood-altering effects after ingesting as little as 10 milligrams.
³Just a sip of coffee,² he says. The drug disappears quickly, typically within 12 hours to 24 hours. This, says Griffiths, explains why coffee is so often a morning ritual: ³People are actually waking up in withdrawal.² Just say no to coffee? Uh, no Griffiths and other caffeine researchers insist that they have nothing against the drug, which has undoubtedly saved lives and careers by helping drowsy drivers, soldiers, aviators, students and machine operators stay awake. Recent research even hints that caffeine helps protect against gallstones and Parkinsonıs disease. ³You donıt lose your job, your friends, or your money by taking caffeine,² says American University psychologist Laura Juliano, who collaborated with Griffiths on the latest review of withdrawal research. ³Thatıs not to say that people donıt do pretty extreme things sometimes to get it.²
For more information about the Johns Hopkins caffeine program, visit: www.caffeine- dependence.org. Some caffeine users want to stop but canıt. To understand why, Griffiths launched a program to study and treat caffeine dependence in 2001. His little-publicized clinic may be the only one of its kind in the nation. The 59 people enrolled in the program keep a diary of caffeine use and have monthly sessions with a therapist. Saliva tests help determine if theyıre sticking to the program. For many, the program works. Nicholson says heıs been clean for two years and now guzzles only caffeine-free Coke. ³The only thing I take with caffeine now is an occasional piece of chocolate,² he says. But some people find they canıt ‹ or donıt want to ‹ quit. Griffiths isnıt surprised. After all, he says, thereıs a reason why caffeine has been popular in so many cultures over the centuries. ³Itıs a great drug,² he says.
The Baltimore Sun reprinted with permission