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John R. Hughes, MD; Stephen T. Higgins, PhD; Warren K. Bickel, PhD; William K. Hunt, PhD; James W. Fenwick, PhD; Suzy B. Gulliver, PhD; Gina C. Mireault

Arch Gen Psychiatry. 1991;48(7):611-617.

Abstract
• Twenty-two coffee drinkers (three to seven cups per day) underwent repeated double-blind trials to test for caffeine self-administration, withdrawal, and adverse effects. Each trial consisted first of a randomized crossover period of 1 day of decaffeinated coffee and 1 day of caffeinated coffee (100 mg) to assess withdrawal and adverse effects of caffeine. Next, subjects were given 2 days of concurrent access to the two coffees. The relative use of the two coffees was used to assess caffeine self-administration. Reliable caffeine self-administration occurred in three of 10 subjects in study 1 and seven of 12 subjects in study 2. Withdrawal symptoms were headaches, drowsiness, and fatigue. The major adverse effect from self-administration was tremulousness. The occurrence of headaches on substitution of decaffeinated coffee prospectively predicted subsequent self-administration of caffeine. These results indicate that some coffee drinkers exhibit signs of a caffeine dependence, ie, they selfadminister coffee for the effects of caffeine, have withdrawal symptoms on cessation, and experience adverse effects.

Author Affiliations
From the Human Behavioral Pharmacology Laboratory, Departments of Psychiatry (Drs Hughes, Higgins, and Bickel), Psychology (Drs Hunt and Gulliver and Ms Mireault), and Medical Biostatics (Dr Fenwick), University of Vermont, Burlington.

Footnotes
Accepted for publication September 10, 1990.

Presented in part at the annual meeting of the American Psychiatric Association, Montreal, Quebec, May 6,1988, and in part at the annual meeting of the Behavioral Pharmacology Society, Annapolis, Md, May 16, 1989.

Reprint requests to Human Behavioral Pharmacology Laboratory, Department of Psychiatry, University of Vermont, 38 Fletcher, Burlington, VT 05401 (Dr Hughes).

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