/ Maggie Koerth-Baker / 10:06 am Tue Jun 11, 2013

High on life (and that third cup of coffee)

The new DSM 5 (and the old DSM-IV, for that matter) includes caffeine intoxication as a valid mental health diagnosis. The new version has also upped the ante, adding "caffeine withdrawal" and "caffeine use disorder" to the list. It's worth noting, though, that the diagnosis criteria is based on a key point — do these behaviors significantly impact the patient's ability to function in daily life. That's, apparently, what makes a difference between everybody in America — sans Mormons — being a caffeine freak, and a few people having a problem. Of course, that distinction is also pretty subjective.

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  1. If someone is drinking 10 cups of coffee and chain smoking, they are self medicating. 

  3. Actually, knowing one former and one kind-of caffeine addict, I’d say that a lot more of those caffeine freaks qualify as “addicted” than you’d think.
    And caffeine withdrawal is a quite unpleasant thing.
    Of course, there is a difference between addicted, dependent and seriously damaged, but that is quite a blurry line, and as with alcohol, you can pass it without noticing, and on embarrassingly small doses.

    1. My ~15 year-old cousin needed medical intervention c. 1973 because he was drinking something like six liters of Coke a day and could no longer perform simple tasks.

      1.  I used to drink at least two 64oz Mountain Dews a day, sometimes three.  I got to the point I stopped drinking this quantity by 3pm, but it was still interfering with my sleep and I would get particularly crabby on the weekends when I didn’t have an opportunity to frequent convenience stores for refills.

        I switched to diet coke and diet DrP and tapered down to one 32oz a day, and then went cold turkey.  I had terrible headaches, even worse sleep patterns, and then after a couple of weeks was back to relative normal.

        I fell off the wagon, now I tend to take a couple of cans of Mountain Dew Throwback a day for breakfast (instead of everyone elses’ coffee) and lunch, and on occasion I do get a cup of soda from a convenience store, but on average I’m drinking 1/5 of the caffeinated soda that I was drinking before and I generally sleep better and function more clearly.

    1. I can have one big cup of coffee a day, but more than that and I can’t concentrate on complex work, so when I’m good I immediately switch to tea.  For anyone seeking to move away from coffee slowly, I recommend a good Russian tea.  In the grand Russian tradition of “if something is worth doing, it’s worth over-doing”, the Russian tea I’ve had is heavy, malty and smoked.  Sort of a breakfast Isley, if you will.

      Alternatively a good Irish or Yorkshire tea.  British regional teas are formulated to match local water (by which I judge Irish and Yorkshire waters need lots and lots of masking).  Both are caffeine rich, heavy, and this is important, steep quickly.  Leaving a bag of Barry’s in a 30oz mug for more than a 10 seconds will render it almost undrinkable.

      1.  Oh, I know about Northern tea, alright. Personally, I like two teabags in a pint mug & leave it to stew. It should be the colour of saddle leather.

        1. Oh, I know about Northern tea, alright. Personally, I like two teabags in a pint mug & leave it to stew. It should be the colour flavour of saddle leather.

  8. I’m really glad I never got into the habit of drinking coffee every.single.day.  I’ve never gotten addicted.  And when I drink it? Even just one cup?  It actually works! I love, love coffee, but have never felt the need to drink it EVERY day, and now I’m never going to get a caffeine headache. Neeener.

    1. I’ve never even tasted the stuff, since it smells like a roofing truck. Just as well, given that a cup of tea gives me cramps, tremors and palpitations.

    2. Yep. It’s a drug that can work like a drug, if we’re not addicted to being almost immune to its effects because we take it every day.

  10. On the plus side, providing somebody with a legal supply of amphetamines is probably a fairly good way of encouraging them to drink less coffee… Who doesn’t like a nice, treatable, psych disorder?

    1.  Honestly, I’ve found drugs (especially uppers) don’t really work any more. Except booze, which is at least reliable.

  11. As someone that works in the field, “significantly impact the patient’s ability to function in daily life.” is something that people often forget when they criticize diagnosis of mental illness.  If it doesn’t impact your life…not an illness.  Simple as that.  Most competent shrinks know that.

  12. So there’s a drug, and it has certain non-psychiatric side effects (e.g. “diuresis” and “gastrointestinal disturbance”) when taken in sufficient quantities.  How exactly is this a mental health diagnosis rather than an ordinary drug side effect?  I can understand if the side effects included, say, [trigger warning] suicidal ideation, but if it just sends you to the toilet frequently, what does that have to do with mental health?

    Suppose I’m taking an SSRI, and it’s causing an array of unpleasant side effects (“I haven’t gotten it up in months, and I no longer really want to, but it’s wrecking my marriage!”).  Suppose I’m taking tetracycline, and it’s causing my skin to be inordinately sensitive to sunlight.  Suppose I’m taking a first-generation antihistamine, and it’s making me drowsy and dry-mouthed.  Are we going to see those in future editions of DSM?  It seems like overreach to me.

  15. i get crazy headaches when i stop drinking coffee, but every time my band goes on tour, i kick it hard (difficult to get, or prioritize, coffee when your van’s broken down on the side of the road in KY and you’ve gotta be in NC that night, for example). i’m pretty much fine a couple days later. that helps a lot, because you don’t always know when you’ll be in a spot long enough to take a huge shit. once you’re off the stuff, and you get to a town and get to chill for 3-4 hours, you can slam some coffee and destroy a toilet.

  16. “How exactly is this a mental health diagnosis rather than an ordinary drug side effect? “See Zak McKracken’s comment. In addition to his input any substance (could be Kool-Aide) taken by a person in excess to the detriment of their health, affect of their daily responsibilities or needing more of said substance to feel desired psycho-physiological results is a drug dependent mental disorder. The DSM is a good quick diagnosis tool but mostly used to price insurance and pharmaceutical costs. Also – the DSM once listed homosexuality as a mental disorder…take it as you will. 

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