Expectancy for Adderall influences subjective mood and drug effects regardless of concurrent caffeine ingestion: A randomized controlled trial.

RATIONALE: Nonmedical prescription stimulant use (NPS; use without a prescription or in ways other than prescribed) is common among college students. Despite the potential for negative consequences, students continue engaging in NPS for cognitive enhancement purposes, which may be maintained by expectancy and placebo effects. OBJECTIVES: This study examined if a placebo administered under the guise of Adderall influenced subjective mood/drug effects and cognitive performance. Furthermore, this study examined if concurrent caffeine ingestion incrementally enhanced Adderall-related placebo effects. METHODS: Undergraduate students with features that put them at elevated risk for NPS (N = 121) completed measures of mood and drug effects and cognitive assessments on two separate laboratory visits in this parallel randomized controlled trial. Visit 1 was a baseline control visit, on which no drug was expected or received. On visit 2, subjects were randomized to: (1) expect/receive no drug (control); (2) expect Adderall/receive placebo; or (3) expect Adderall/receive 200 mg caffeine. RESULTS: There were several significant condition × visit interactions for subjective effects, including amphetamine effects, energy and efficiency effects, and feeling high. In most cases, participants who expected Adderall reported greater positive subjective effects on visit 2 compared to controls; however, there were generally not incremental enhancements for those ingesting caffeine compared to placebo. There were no significant effects for any cognitive tests. CONCLUSIONS: Expectation for prescription stimulant effects influenced subjective outcomes in a sample of high-risk college students. These findings may inform expectancy challenge interventions to reduce NPS. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03648684.

Stop the Pop: A Mixed-Methods Study Examining Children's Physical and Emotional Responses during Three Days of Sugary Drink Cessation.

Despite public health efforts to reduce sugary drink consumption, children's intake continues to exceed recommendations. While numerous barriers to lowering sugary drink consumption have been identified, aversive feelings during sugary drink cessation may further challenge sustained reduction in children's sugary drink consumption. Herein, we describe "Stop the Pop", an intervention to examine children's physical and emotional responses during three days of sugary drink cessation. Children (n = 150) ages 8-14, who reported habitual consumption of ≥12 ounces of sugary drinks daily, were instructed to avoid sweetened beverages for three days. At baseline and on each day of cessation, children completed a daily feelings questionnaire, and a subset of children (n = 30) also completed a qualitative interview following cessation. During sugary drink cessation, children reported physical and emotional improvements, including being less tired, angry, and annoyed; having less trouble sleeping; and less frequently arguing with others, getting in trouble, and getting mad. However, unfavorable responses, such as mood disturbances and having less energy, were reported by some participants. Our results suggest that children who habitually consume sugary drinks may experience physical and emotional improvements during short-term sugary drink cessation, although longer-term examination is needed and inter-individual variability in responses to cessation warrants further study.

Lower self-efficacy and greater depressive symptoms predict greater failure to recover from a single lapse cigarette.

OBJECTIVE: Smoking reexposure after a quit attempt (i.e., lapse) increases relapse risk, but lapse recovery is possible. Using a 6-day analogue model of smoking cessation and lapse, this study tested the effect of a single lapse cigarette on the risk of subsequent smoking. Abstinence self-efficacy (ASE) and depressive symptoms (using the Center for Epidemiological Studies Depression Scale, CES-D) were also examined as hypothesized moderators of lapse recovery. METHOD: After receiving cessation counseling and achieving 2 days of incentivized abstinence, 54 daily smokers (mean age: 41 years, 61% African American, 63% male) were randomly assigned to smoke 1 cigarette or to a no-lapse control condition. Participants were then offered monetary incentives to abstain for 3 more days and smoking was monitored. RESULTS: Compared to the control condition, participants who experienced a lapse had a 2.5 times greater risk of smoking in the first 24 hours Furthermore, a lapse resulted in much greater risk of subsequent smoking compared to the control condition among individuals with lower postquit ASE scores (p = .044) and greater CES-D scores (p = .040). CONCLUSIONS: These findings provide preliminary evidence that a single lapse cigarette after quitting plays a causal role in subsequent smoking and suggest that individuals with lower postquit ASE and greater depressive symptoms are less likely to recover from a lapse. Future research should investigate factors associated with lapse recovery and failure so that effective lapse-responsive strategies can be developed. Laboratory models provide an efficient and controlled method to examine such processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Differences in Smoking Topography and Subjective Responses to Smoking Among African American and White Menthol and Non-Menthol Smokers.

INTRODUCTION: It has been suggested that menthol increases exposure to harmful elements of smoking and makes smoking more rewarding, easier to initiate, and harder to quit. Isolating the direct effects of menthol is challenging as African American (AA) race and menthol preference are highly overlapping. This study evaluated smoking behavior and subjective responses among a balanced sample of AA and white menthol and non-menthol smokers. In addition, smoking topography (ST) was compared to naturalistic smoking (NS) and interactions with menthol and race were explored. AIMS AND METHODS: Smokers (N = 100) smoked and rated their preferred brand of cigarettes via ST or NS during two laboratory visits (counterbalanced). RESULTS: Controlling for baseline differences among the groups (eg, nicotine dependence), menthol smokers took shorter and smaller puffs and AA smokers took longer puffs, but there were no differences in total puff volume, carbon monoxide, or other ST parameters. Menthol smokers reported greater urge reduction and lower sensory stimulation. The smoking method (ST vs. NS) had no effects on smoking behavior or exposure. Cigarettes smoked via ST were rated stronger. Differences in satisfaction based on the smoking method interacted with race and menthol status. Ratings of aversion differed by race and menthol status. CONCLUSIONS: Menthol was not associated with increased smoke exposure or reward (except for urge reduction). ST caused minimal experimental reactivity relative to NS. Additional research that isolates the effects of menthol and examines potential interactive effects with race and other variables is needed to better understand its role in smoking-related health disparities. IMPLICATIONS: Menthol and non-menthol smokers differed on some demographic variables and menthol preference was associated with greater nicotine dependence and greater urge reduction after smoking. Menthol was not associated with greater smoke exposure. Future research that investigates the unique risks associated with menthol and examines potential interactive effects with race and other related variables is warranted to better understand the role of menthol in smoking-related health disparities.

Obstetrician-gynecologists' screening and management of depression during perimenopause.

OBJECTIVE: Depression in women is more common during perimenopause (the time period around and during menopause) than pre and postmenopause. Obstetrician-gynecologists (ob-gyns) play a vital role in the detection and management of depression symptoms in women because for many women ob-gyns are the first and most frequent point of medical contact. This study assessed ob-gyns' screening practices and management of depression in perimenopause. METHODS: A survey regarding depression during perimenopause was sent to 500 practicing ob-gyns who were fellows of the American College of Obstetricians and Gynecologists and members of the Collaborative Ambulatory Research Network. RESULTS: The survey response rate was 41.8% (209 of 500 surveys returned). Over a third of respondents (34.1%) reported that they did not regularly screen perimenopausal patients for depression. Higher-quality education about depression, respondent sex, and personal experience with depression were associated with higher rates of screening. While 85.7% of respondents believed that they could recognize depression in perimenopausal women, only about half (55.8%) were confident in their ability to treat these patients. CONCLUSION: Increased education of ob-gyn physicians related to depression during perimenopause may increase the screening and treatment of women during this phase of life.

The effects of mindfulness-based yogic breathing on craving, affect, and smoking behavior.

Breathing practices are often incorporated into treatments for tobacco dependence, but there is little direct research testing the efficacy of breathing practices. This study examined the effects of a mindfulness-based yogic breathing (MB) intervention versus active treatment (cognitive strategy [CS]) and no-treatment (NT) control groups on craving, affect, withdrawal, and smoking behavior. Smokers (N = 60; 50% female; 83% African American) were randomized to receive 20 min of MB, CS, or NT. Participants completed self-report measures before and after the manipulation and then took part in a 50-min smoking choice procedure. Afterward, participants were advised to use the techniques they learned and self-monitor smoking for 24 hr. They received 3 reminder text messages and returned to the lab the following day. MB and CS were more effective than NT in decreasing craving to smoke and perceived nicotine withdrawal. MB, but not CS, was more effective than NT in reducing negative affect. MB reduced the risk of smoking by more than twofold relative to both CS and NT during the smoking choice procedure. Participants in the MB condition smoked fewer cigarettes than those in the CS and NT conditions in the 24 hr following the manipulation. There were no differential effects of the manipulations on state mindfulness or positive affect. Mindful yogic breathing appears to be particularly effective in alleviating the acute negative effects of smoking abstinence and decreasing smoking behavior. Mindful breathing techniques are safe, simple, and cost-effective strategies that deserve additional research attention, especially among underserved populations of smokers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Investigating the role of expectancy in caffeine withdrawal using the balanced placebo design.

OBJECTIVE: This study investigated psychological influences on drug withdrawal symptomatology using a caffeine-based model. METHODS: Using the 2 × 2 balanced placebo design caffeine dose (given caffeinated vs decaffeinated coffee) was crossed with dose expectancy (told caffeine vs. decaf) among 87 (16-hr abstinent) regular coffee consumers in a 2-day study. RESULTS: There were effects of expectancy and pharmacology that differed depending on the measure. Those told decaf reported greater caffeine cravings than those told caffeine 45 min and 8 hr postmanipulation. There were no expectancy effects on withdrawal symptoms or cognitive performance. There were pharmacological effects on all measures. Those given decaf reported greater withdrawal symptoms and showed poorer cognitive performance 45 min and 8 hr postmanipulation, with effects for headache and flu-like symptoms first emerging 8 hr postmanipulation (i.e., 24 hr abstinence in given decaf conditions). Caffeine readministration alleviated all withdrawal symptoms and cognitive decrements within 45 min. No drug by expectancy interactions were observed. CONCLUSIONS: These findings confirm a strong pharmacological basis for caffeine withdrawal and an important role of cognition in drug craving. Future research should investigate the role of expectancy in drug withdrawal and craving and the potential use of expectancy manipulations in symptom prevention and management.

A randomized controlled trial of a manual-only treatment for reduction and cessation of problematic caffeine use.

BACKGROUND: Caffeine Use Disorder was added to DSM-5 as a diagnosis for further research, but few studies have been conducted to identify effective treatments. This randomized, controlled clinical trial examined the efficacy of a manual-only treatment program for caffeine cessation and reduction among individuals seeking treatment for problematic caffeine use. METHODS: Individuals meeting at least two proposed DSM-5 diagnostic criteria for Caffeine Use Disorder were randomly assigned to receive either immediate treatment or treatment delayed by 7 weeks. The treatment consisted of a manual containing information about caffeine and instructions for gradually reducing caffeine consumption over a period of 6 weeks, with no counseling or additional support. Caffeine consumption and caffeine-related distress were assessed before treatment, 7 weeks after receiving the treatment manual (end-of-treatment), and 20 weeks post-treatment. RESULTS: The manual-only treatment resulted in significant reductions in participants' self-reported caffeine consumption and caffeine-related distress at end-of-treatment that were sustained at 20-weeks post-treatment. Salivary caffeine levels and community observers corroborated the self-reported reductions in caffeine consumption. Comparisons between the immediate and delayed treatment groups suggest the reductions in caffeine consumption were attributable to the manualized treatment rather than spontaneous with the passage of time. CONCLUSIONS: The present study provides evidence that a gradual caffeine reduction and cessation program may be successfully implemented using a manual-only approach. This time- and cost-effective intervention may be easily adopted by practitioners with limited time or experience with behavioral interventions who want to encourage their patients to reduce caffeine consumption.

Does early exposure to caffeine promote smoking and alcohol use behavior? A prospective analysis of middle school students.

BACKGROUND AND AIMS: Despite the negative consequences associated with caffeine use among children and youth, its use is increasingly widespread among middle school students. Cross-sectional studies reveal links between caffeine and other substance use. The potential for caffeine use to confer increased vulnerability to substance use, however, has not been investigated using prospective designs. We hypothesized that caffeine use at baseline would be associated positively with increased alcohol use, drunkenness, smoking and e-cigarette use. DESIGN: Prospective cohort study with 12 months separating baseline from follow-up. SETTING: West Virginia, USA. PARTICIPANTS: Middle school students (6th and 7th grades; n = 3932) in three West Virginia (WV) counties provided data at baseline and follow-up 12 months later. MEASUREMENTS: Youth self-reported their use of caffeine from multiple sources (e.g. soda, energy drinks, coffee and tea), cigarette smoking, electronic cigarette use, alcohol use and drunkenness. FINDINGS: Cross-lagged path models for individual substance use categories provided a good fit to the data. Controlling for demographic variables and other substance use at baseline, caffeine at time 1 (T1) was associated positively with T2 cigarette smoking (ß = 0.27, P = 0.001), e-cigarette use (ß = 0.21, P = 0.001), alcohol use (ß = 0.17, P = 0.001) and drunkenness (ß = 0.15, P = 0.001). Conversely, non-significant relations emerged between three of four substances at T1 and caffeine at T2. Positive relations were found between e-cigarette use at T1 and caffeine use at T2 (ß = 0.07, P = 0.006). These findings were supported by an omnibus model with all substances included. Specifically, significant relations were observed between caffeine at T1 and all substance use outcomes at T2, whereas no significant relations were observed between substance use and caffeine over time. CONCLUSIONS: Caffeine may promote early use of other types of substances among middle school-aged adolescents.

Predictors of smoking lapse during a 48-hour laboratory analogue smoking cessation attempt.

Many individuals who attempt to quit smoking experience a smoking lapse early on in the quitting process, with most lapses resulting in a return to regular smoking. Using a novel laboratory model, this study sought to investigate baseline predictors of smoking lapse during a brief, simulated smoking quit attempt. Self-report baseline measures were completed by 81 smokers, who also smoked a cigarette in the laboratory to equate recent smoke exposure. Participants were then given brief face-to-face smoking-cessation counseling along with monetary incentives to abstain from smoking for 48 hr (i.e., $40). Participants returned to the laboratory after 24 hr and 48 hr for assessment of smoking behavior. By 48 hr, 25 participants lapsed, with rates equivalent among men and women (31% vs. 31%). Higher rates of delay discounting and a preference for menthol cigarettes significantly predicted greater odds of lapsing. Shorter time to first cigarette after waking (TTFC) was associated with greater lapse risk at trend levels. No effects were observed for demographic variables, cigarettes per day, prequit abstinence self-efficacy, or depressive symptoms. Future research examining predictors of early lapse and underlying mechanisms is needed, and laboratory analogue models offer a controlled time- and cost-effective framework in which to investigate smoking cessation processes. (PsycINFO Database Record

A brief manualized treatment for problematic caffeine use: A randomized control trial.

OBJECTIVE: The goal of the present investigation was to develop and test a brief therapist-guided manualized treatment for problematic caffeine use, including cognitive-behavioral strategies and 5 weeks of progressively decreased consumption. METHOD: Individuals seeking treatment for problematic caffeine use (mean daily caffeine consumption of 666 mg at baseline) were randomized using a waitlist-control design to receive immediate treatment (N = 33) or delayed treatment (∼6 weeks later; N = 34). A 1-hr treatment session designed to help individuals quit or reduce caffeine consumption was provided by a trained counselor along with a take-home booklet. After the treatment session, participants completed daily diaries of caffeine consumption for 5 weeks. They returned for follow-up assessments at 6, 12, and 26 weeks and had a telephone interview at 52-weeks posttreatment. RESULTS: Treatment resulted in a significant reduction in self-reported caffeine use and salivary caffeine levels. No significant posttreatment increases in caffeine use were observed for up to 1 year follow-up. Comparisons to the waitlist-control condition revealed that reductions in caffeine consumption were due to treatment and not the passing of time, with a treatment effect size of R² = .35 for the model. CONCLUSION: A brief 1-session manualized intervention with follow-up was efficacious at reducing caffeine consumption. Future researchers should replicate and extend these findings, as well as consider factors affecting dissemination of treatment for problematic caffeine use to those in need.

Smoking Through a Topography Device Diminishes Some of the Acute Rewarding Effects of Smoking.

BACKGROUND: Smoking topography (ST) devices are an important methodological tool for quantifying puffing behavior (eg, puff volume, puff velocity) as well as identifying puffing differences across individuals and situations. Available ST devices are designed such that the smoker's mouth and hands have direct contact with the device rather than the cigarette itself. Given the importance of the sensorimotor aspects of cigarette smoking in smoking reward, it is possible that ST devices may interfere with the acute rewarding effects of smoking. Despite the methodological importance of this issue, few studies have directly compared subjective reactions to smoking through a topography device to naturalistic smoking. METHODS: Smokers (N = 58; 38% female) smoked their preferred brand of cigarettes one time through a portable topography device and one time naturalistically, in counterbalanced order across two laboratory sessions. Smoking behavior (eg, number of puffs) and subjective effects (eg, urge reduction, affect, smoking satisfaction) were assessed. RESULTS: Negative affect reduction was greater in the natural smoking condition relative to the topography condition, but differences were not significant on measures of urge, withdrawal, or positive affect. Self-reported smoking satisfaction, enjoyment of respiratory tract sensations, psychological reward, craving reduction, and other rewarding effects of smoking were also significantly greater in the naturalistic smoking condition. CONCLUSIONS: The effects of using a ST device on the smoking experience should be considered when it is used in research as it may diminish some of the rewarding effects of smoking. IMPLICATIONS: When considering the inclusion of a smoking topography device in one's research, it is important to know if use of that device will alter the smoker's experience. This study assessed affective and subjective reactions to smoking through a topography device compared to naturalistic smoking. We found that smoking satisfaction, psychological reward, enjoyment of respiratory tract sensations and other rewarding effects were all diminished when smoking through the topography device. The effects of using a smoking topography device on the smoking experience should be considered when it is used in future research.

Evaluating the Validity of Caffeine Use Disorder.

Caffeine use disorder is included in the conditions for further study section of the DSM-5. Caffeine's profile of neurobiological, behavioral, and clinical effects is similar to other common substances that humans use recreationally. Extant data suggest that a clinically meaningful addictive disorder develops in some regular caffeine users, but this literature is incomplete and not yet sufficient to determine if and how best to define and treat caffeine use disorder. An overview of the literature relevant to determining the clinical importance of problematic caffeine use is followed by discussion of potential concerns and benefits associated with its classification as a mental disorder. Concerns about overdiagnosis and trivialization of other psychiatric syndromes are weighed against the public health benefits of increased awareness and development of interventions targeting problematic caffeine use. This discussion includes consideration of alternative diagnostic approaches, improvement of assessment practices, and the need for additional clinical and epidemiological research.

Perceived smoking availability differentially affects mood and reaction time.

INTRODUCTION: This between subjects study explored the relationship between smoking availability and smoking motivation and is the first study to include three smoking availability time points. This allowed for an examination of an extended period of smoking unavailability, and a test of the linearity of the relationships between smoking availability and smoking motivation measures. METHODS: Ninety 3-hour abstinent smokers (mean ~15 cigarettes per day) were randomly assigned to one of three availability manipulations while being exposed to smoking stimuli (i.e., pack of cigarettes): smoke in 20 min, smoke in 3 h, or smoke in 24 h. Participants completed pre- and post-manipulation measures of urge, positive affect and negative affect, and simple reaction time. RESULTS: The belief that smoking would next be available in 24 h resulted in a significant decrease in positive affect and increase in negative affect relative to the 3 h and 20 min conditions. A Lack of Fit test suggested a linear relationship between smoking availability and affect. A quadratic model appeared to be a better fit for the relationship between smoking availability and simple reaction time with participants in the 24 h and 20 min conditions showing a greater slowing of reaction time relative to the 3 h condition. There were no effects of the manipulations on self-reported urge, but baseline ceiling effects were noted. CONCLUSIONS: Future investigations that manipulate three or more periods of time before smoking is available will help to better elucidate the nature of the relationship between smoking availability and smoking motivation.

Caffeine Withdrawal and Dependence: A Convenience Survey Among Addiction Professionals.

AIMS: Caffeine withdrawal was included in the research appendix of the DSM-IV to encourage additional research to assist with determining its status for the next version of the manual. Caffeine dependence was not included because of a lack of empirical research at the time of publication. This study assessed the beliefs of addiction professionals about the clinical importance of caffeine withdrawal and dependence. METHODS: A 6-item survey was developed and delivered electronically to the members of six professional organizations that focus on addiction. Open-ended comments were also solicited. Five hundred members responded. RESULTS: The majority (95%) thought that cessation of caffeine could produce a withdrawal syndrome, and that caffeine withdrawal can have clinical importance (73%); however, only half (48%) thought that caffeine withdrawal should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A majority (58%) believed that some people develop caffeine dependence; however, only 44% indicated that it should be in the DSM. Comments suggested that trepidation about inclusion of caffeine diagnoses was due to the concerns about the field of psychiatry being criticized for including common disorders with a relatively low clinical severity. Others, however, expressed an urgent need to take caffeine-related problems more seriously. CONCLUSIONS: The majority of addiction professionals believe that caffeine withdrawal and dependence disorders exist and are clinically important; however, these professionals are divided in whether caffeine withdrawal and dependence should be included in DSM. Wider dissemination of the extant literature on caffeine withdrawal and additional research on caffeine dependence will be needed to provide additional guidance to policymakers and healthcare workers.

Caffeine Use Disorder: A Comprehensive Review and Research Agenda.

Caffeine is the most commonly used drug in the world. Although consumption of low to moderate doses of caffeine is generally safe, an increasing number of clinical studies are showing that some caffeine users become dependent on the drug and are unable to reduce consumption despite knowledge of recurrent health problems associated with continued use. Thus, the World Health Organization and some health care professionals recognize caffeine dependence as a clinical disorder. In this comprehensive literature review, we summarize published research on the biological evidence for caffeine dependence; we provide a systematic review of the prevalence of caffeine dependence and rates of endorsement of clinically meaningful indicators of distress and functional impairment among habitual caffeine users; we discuss the diagnostic criteria for Caffeine Use Disorder-a condition for further study included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.); and we outline a research agenda to help guide future clinical, epidemiological, and genetic investigations of caffeine dependence. Numerous controlled laboratory investigations reviewed in this article show that caffeine produces behavioral and physiological effects similar to other drugs of dependence. Moreover, several recent clinical studies indicate that caffeine dependence is a clinically meaningful disorder that affects a nontrivial proportion of caffeine users. Nevertheless, more research is needed to determine the reliability, validity, and prevalence of this clinically important health problem.

A direct test of the influence of nicotine response expectancies on the subjective and cognitive effects of smoking.

Regardless of actual nicotine content, expectations about the nicotine content of a cigarette influence the rewarding subjective effects of smoking, and may even affect cognitive performance. These effects are theorized to be mediated by beliefs about effects of cigarette smoking, or response expectancies. However, few studies have directly manipulated response expectancies. Understanding the effects of such manipulations could improve effectiveness of nicotine-dependence treatments and medications. Using a 2 × 2 between-subjects factorial design, cigarette smokers (N = 80) smoked either a nicotine or a placebo (denicotinized) cigarette crossed with instructions that the cigarette would either enhance or impair cognitive and motor performance. As predicted, participants in the "told enhance" condition reported significantly greater beliefs that nicotine had beneficial effects on performance than those in the "told impair" condition. Compared to those "told impair," those "told enhance" reported more psychological reward, enjoyable physical sensations, and craving reduction from the cigarette, as well as greater motivation to perform well on a cognitive task. Relative to placebo cigarettes, nicotine cigarettes produced greater reports of satisfaction, craving reduction, and dizziness. Smoking a nicotine cigarette produced better performance on the Rapid Visual Information Processing Task, a test of sustained attention; but the expectancy manipulation had no effect. These data suggest that response expectancies can be experimentally manipulated and can influence perceived rewarding effects of cigarette smoking, but do not appear to affect cognitive performance. These findings add to our understanding of the benefits and limitations of expectancy manipulations, both experimentally and as a treatment technique.

Characterization of individuals seeking treatment for caffeine dependence.

Previous investigations have identified individuals who meet criteria for Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) substance dependence as applied to caffeine, but there is little research on treatments for caffeine dependence. This study aimed to thoroughly characterize individuals who are seeking treatment for problematic caffeine use. Ninety-four individuals who identified as being psychologically or physically dependent on caffeine, or who had tried unsuccessfully to modify caffeine consumption participated in a face-to-face diagnostic clinical interview. They also completed measures concerning caffeine use and quitting history, reasons for seeking treatment, and standardized self-report measures of psychological functioning. Caffeine treatment seekers (mean age 41 years, 55% women) consumed an average of 548 mg caffeine per day. The primary source of caffeine was coffee for 50% of the sample and soft drinks for 37%. Eighty-eight percent reported prior serious attempts to modify caffeine use (mean 2.7 prior attempts), and 43% reported being advised by a medical professional to reduce or eliminate caffeine. Ninety-three percent met criteria for caffeine dependence when generic DSM-IV-TR substance dependence criteria were applied to caffeine use. The most commonly endorsed criteria were withdrawal (96%), persistent desire or unsuccessful efforts to control use (89%), and use despite knowledge of physical or psychological problems caused by caffeine (87%). The most common reasons for wanting to modify caffeine use were health-related (59%) and not wanting to be dependent on caffeine (35%). This investigation reveals that there are individuals with problematic caffeine use who are seeking treatment and suggests that there is a need for effective caffeine dependence treatments.

Development of the caffeine withdrawal symptom questionnaire: caffeine withdrawal symptoms cluster into 7 factors.

BACKGROUND: Habitual caffeine consumers who abstain from caffeine experience withdrawal symptoms such as headache, fatigue, difficulty concentrating, mood disturbances, and flu-like symptoms (Juliano and Griffiths, 2004). The caffeine withdrawal syndrome has been documented across many experimental studies; however, little is known about how withdrawal symptoms co-vary during a discrete episode. Furthermore, a validated measure of caffeine withdrawal is lacking. OBJECTIVE: To develop, evaluate, and reduce a 23-item measure of caffeine withdrawal symptoms; the Caffeine Withdrawal Symptom Questionnaire (CWSQ), to a set of composite variables. METHODS: Caffeine consumers (N=213) completed the CWSQ after 16h of caffeine abstinence. A subset of participants also completed the CWSQ during a preceding baseline period and/or after double-blind consumption of caffeinated coffee. RESULTS: Principal components analysis resulted in a solution comprised of 7-factors: (1) Fatigue/drowsiness; (2) Low alertness/difficulty concentrating; (3) Mood disturbances; (4) Low sociability/motivation to work; (5) Nausea/upset stomach; (6) Flu-like feelings; and (7) Headache. With the exception of nausea/upset stomach, the CWSQ total score and individual composite scores were significantly greater during caffeine abstinence relative to both baseline and double-blind consumption of caffeinated coffee, thereby demonstrating sensitivity of the measure. Compared to non-daily coffee consumers, daily consumers had greater increases in total withdrawal, fatigue/drowsiness, low alertness/difficulty concentrating, mood disturbances, and headache. CONCLUSIONS: Future directions include replication, assessment on a clinical population, and further examination of psychometric properties of the CWSQ. The CWSQ should facilitate the assessment and diagnosis of caffeine withdrawal and increase our knowledge of the caffeine withdrawal syndrome.

Caffeine Expectancy Questionnaire (CaffEQ): construction, psychometric properties, and associations with caffeine use, caffeine dependence, and other related variables.

Expectancies for drug effects predict drug initiation, use, cessation, and relapse, and may play a causal role in drug effects (i.e., placebo effects). Surprisingly little is known about expectancies for caffeine even though it is the most widely used psychoactive drug in the world. In a series of independent studies, the nature and scope of caffeine expectancies among caffeine consumers and nonconsumers were assessed, and a comprehensive and psychometrically sound Caffeine Expectancy Questionnaire (CaffEQ) was developed. After 2 preliminary studies, the CaffEQ was administered to 1,046 individuals from the general population along with other measures of interest (e.g., caffeine use history, anxiety). Exploratory factor analysis of the CaffEQ yielded a 7-factor solution. Subsequently, an independent sample of 665 individuals completed the CaffEQ and other measures, and a subset (n = 440) completed the CaffEQ again approximately 2 weeks later. Confirmatory factor analysis revealed good model fit, and test-retest reliability was very good. The frequency and quantity of caffeine use were associated with greater expectancies for withdrawal/dependence, energy/work enhancement, appetite suppression, social/mood enhancement, and physical performance enhancement and lower expectancies for anxiety/negative physical effects and sleep disturbance. Caffeine expectancies predicted various caffeine- associated features of substance dependence (e.g., use despite harm, withdrawal incidence and severity, perceived difficulty stopping use, tolerance). Expectancies for caffeine consumed via coffee were stronger than for caffeine consumed via soft drinks or tea. The CaffEQ should facilitate the advancement of our knowledge of caffeine and drug use in general.