6. Continued caffeine use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of caffeine (e.g., arguments with spouse about consequences of use, medical problems, cost).
7. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of caffeine to achieve desired effect.
b. Markedly diminished effect with continued use of the same amount of caffeine.
8. A great deal of time is spent in activities necessary to obtain caffeine, use caffeine, or recover from its effects.
9. Craving or a strong desire or urge to use caffeine.
A diagnosis of substance dependence due to caffeine is recognized by the World Health
Organization in ICD-10. Since the publication of DSM-IV in 1994, considerable research on caffeine dependence has been published, and several recent reviews provide a current analysis of this literature. There is now sufficient evidence to warrant inclusion of caffeine use disorder as a research diagnosis in DSM-S to encourage additional research. The work- ing diagnostic algorithm proposed for the study of caffeine use disorder differs from that of the other substance use disorders, reﬂecting the need to identify only cases that have sufficient clinical importance to warrant the labeling of a mental disorder. A key goal of in- cluding caffeine use disorder in this section of DSM-S is to stimulate research that will determine the reliability, validity, and prevalence of caffeine use disorder based on the proposed diagnostic schema, with particular attention to the association of the diagnosis with functional impairments as part of validity testing.
The proposed criteria for caffeine use disorder reﬂect the need for a diagnostic thresh- old higher than that used for the other substance use disorders. Such a threshold is in- tended to prevent overdiagnosis of caffeine use disorder due to the high rate of habitual nonproblematic daily caffeine use in the general population.
Caffeine use disorder is characterized by the continued use of caffeine and failure to con- trol use despite negative physical and / or psychological consequences. In a survey of the general population, 14% of caffeine users met the criterion of use despite harm, with most reporting that a physician or counselor had advised them to stop or reduce caffeine use within the last year. Medical and psychological problems attributed to caffeine included heart, stomach, and urinary problems, and complaints of anxiety, depression, insomnia, irritability, and difficulty thinking. In the same survey, 45% of caffeine users reported de- sire or unsuccessful efforts to control caffeine use, 18% reported withdrawal, 8% reported tolerance, 28% used more than intended, and 50% reported spending a great deal of time using caffeine. In addition, 19% reported a strong desire for caffeine that they could not re- sist, and less than 1% reported that caffeine had interfered with social activities.
Among those seeking treatment for quitting problematic caffeine use, 88% reported having made prior serious attempts to modify caffeine use, and 43% reported having been advised by a medical professional to reduce or eliminate caffeine. Ninety—three percent endorsed signs and symptoms meeting DSM-IV criteria for caffeine dependence, with the most commonly endorsed criteria being withdrawal (96%), persistent desire or unsuccess- ful 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 caf— feine use Were health-related (59%) and a desire to not be dependent on caffeine (35%).
The DSM-S discussion of caffeine withdrawal in the Section 11 chapter ”Substance-