Strain E C, Mumford G K, Silverman K, Griffiths R R
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Md 21224.
JAMA. 1994 Oct 5;272(13):1043-8.
The extent to which daily caffeine use is associated with a substance dependence syndrome similar to that associated with other psychoactive drugs is unknown. The purpose of this study was to assess volunteers who reported problems with their use of caffeine for evidence suggesting a diagnosis of caffeine dependence based on the generic criteria for substance dependence from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
Case-series evaluations.
An academic research center.
Self-identified adults who believed they were psychologically or physically dependent on caffeine.
Diagnoses made by a psychiatrist using a structured clinical interview that included a section on caffeine dependence based on genetic criteria for DSM-IV substance dependence.
Double-blind caffeine-withdrawal evaluation.
Ninety-nine subjects were screened for the study, and 16 were identified as having a diagnosis of caffeine dependence. Median daily caffeine intake was 357 mg, and 19% of subjects consumed less than the national (US) daily average of caffeine. Criteria used for making diagnoses (and rates of their prevalence) were as follows: withdrawal (94%), use continued despite knowledge of a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by caffeine use (94%), persistent desire or unsuccessful efforts to cut down or control use (81%), and tolerance (75%). Eleven subjects underwent the double-blind caffeine-withdrawal evaluation portion of the study, and nine (82%) of the 11 showed objective evidence of caffeine withdrawal, including eight of 11 with functional impairment.
These results, together with other experimental evidence, suggest that caffeine exhibits the features of a typical psychoactive substance of dependence. It is valuable to recognize caffeine dependence as a clinical syndrome, since some people feel compelled to continue caffeine use despite desires and recommendations to the contrary.
每日咖啡因使用与一种类似于其他精神活性药物所致物质依赖综合征的关联程度尚不清楚。本研究的目的是评估那些报告有咖啡因使用问题的志愿者，以寻找基于《精神疾病诊断与统计手册》第四版（DSM-IV）中物质依赖通用标准诊断咖啡因依赖的证据。
病例系列评估。
一个学术研究中心。
自我认定在心理或生理上对咖啡因有依赖的成年人。
精神科医生通过结构化临床访谈做出的诊断，该访谈包括基于DSM-IV物质依赖通用标准的咖啡因依赖部分。
双盲咖啡因戒断评估。
99名受试者接受了该研究的筛查，16人被诊断为咖啡因依赖。受试者每日咖啡因摄入量中位数为357毫克，19%的受试者摄入量低于美国全国每日咖啡因平均摄入量。用于诊断的标准（及其患病率）如下：戒断（94%）、尽管知道咖啡因使用可能已导致或加剧持续或反复出现的身体或心理问题仍继续使用（94%）、持续渴望或减少或控制使用的努力未成功（81%）以及耐受性（75%）。11名受试者接受了该研究的双盲咖啡因戒断评估部分，11人中的9人（82%）显示出咖啡因戒断的客观证据，包括11人中的8人有功能损害。
这些结果与其他实验证据一起表明，咖啡因具有典型精神活性依赖物质的特征。将咖啡因依赖识别为一种临床综合征很有价值，因为有些人尽管有相反的意愿和建议，仍感到不得不继续使用咖啡因。
