IF YOU thought that a cappuccino or double espresso was a good way to jump-start the day, be warned: that cup of coffee could indicate that you are suffering from a psychological disorder. Indeed, caffeine dependence is now seen as a true addiction, and it is likely that caffeine withdrawal will be included in the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

Professor Roland Griffiths, a neuroscientist at Johns Hopkins School of Medicine in Baltimore, is among the scientists who have recommended that caffeine dependence be viewed as an addiction and treated accordingly. He recently published in the Journal of Psychopharmacology a review of almost 70 scientific studies into caffeine’s effect on health and behaviour (his study was partly funded by the National Institute on Drug Abuse), and says that the problem of caffeine dependence has gone unrecognised for too long. Caffeine is “the most commonly consumed moodaltering drug in the world”: it crops up not just in coffee but also in chocolate, soft drinks, tea and over-the-counter medications. “About 80 per cent of the Western population takes caffeine, so millions of people could be physically dependent,” he says.

Doctors should have the means to diagnose caffeine dependence, says Professor Griffiths, so that they “can provide correct diagnosis for other medical conditions whose symptoms overlap with those of caffeine withdrawal. And some patients may need to be told to quit caffeine intake for medical reasons”. Medical professionals also “need to appreciate the difficulty some people have in cutting out caffeine and be prepared to follow guidelines that offer an alternative to its abrupt cessation”.

In Britain 70 million cups of coffee are drunk every day, with the average person drinking 421 cups a year. Professor Griffiths says as little as 100mg of caffeine — the amount in half a cup of instant coffee (and a third of the estimated average daily intake in the US and UK, 280mg) can lead to physical dependence in some people. He suggests that at least 50 per cent of regular caffeine consumers would suffer from withdrawal symptoms if they abstained. And, he adds, the symptoms could flare up regardless of the product used.

“Most people know it is a mild stimulant, but are not aware that abrupt cessation can trigger unpleasant side-effects,” Professor Griffiths says. Symptoms include headaches, fatigue and drowsiness, depression or irritability, reduced concentration and flu-like signs such as nausea and muscle pain. Typically these become apparent 12 to 24 hours after caffeine intake is halted, and the unpleasantness peaks after two days. However, some people find that the effects linger for up to two weeks, and about 13 per cent experience “clinically significant distress or functional impairment”, which usually leaves them taking up to nine days off work in the belief that they have a virus or flu.

Needing a caffeine shot to start your day could be a sign that you are already addicted. “What people don’t recognise is that the boost they get with that first cup of coffee in the morning is a reversal of low-grade withdrawal effects,” Professor Griffiths explains. In his studies, many subjects who were hooked on a “java jolt” unwittingly took caffeine to ward off withdrawal symptoms rather than to enjoy the temporary boost.

So concerned is Professor Griffiths that he and his colleagues have set up what is thought to be the first dedicated caffeine addiction clinic to help people kick the habit. Based at Johns Hopkins University, the centre attracts everyone from business people to students who rely too heavily on tea, coffee, cola and products such as Red Bull to supply energy boosts throughout the day. The philosophy is not to go cold turkey but to wean people off gradually. Patients undergo an assessment in which staff look at their total intake. “We then teach a systematic method of gradually reducing consumption over time by substituting decaffeinated or non-caffeinated products,” Professor Griffiths says.

The time it takes to detox completely depends on your caffeine habit, though all patients cut their consumption by 25 per cent each week. No alternative pain-killing medication is offered. “Caffeine itself is the best medication for offsetting those symptoms, which is why we reduce it slowly,” Professor Griffiths says. This is why caffeine is not banned at the clinic, just strictly controlled.

Last year Lois Smith, a businesswoman, was drinking 12 cups of coffee a day. “I’d wake up and my first thought was ‘Get to Starbucks and get a coffee’,” she says. After six weeks on the programme she was caffeine-free and now her preferred drink is herbal tea, though she admits to the occasional craving: “I sometimes think I might enjoy just that one cup of coffee, but then I remember the withdrawal symptoms,” she says. “It ’s not worth having even one cup.”

Professor Griffiths himself drinks the occasional coffee, and is not opposed to appropriate caffeine use. “But people must understand that it is a drug, and accord it respect as a drug.”

HOW TO KICK THE HABIT

1 Caffeine dependence varies with the individual — as little as half a cup a day can have some people hooked.

2 Calculate your caffeine intake and its sources. These include tea, coffee, cola and some sports or energy drinks as well as over-the-counter medication and products such as ProPlus.

3 Don’t go cold turkey — it will trigger adverse symptoms and make you more likely to return to caffeine.

4 Reduce your consumption by 25 per cent or thereabouts each week: if you are currently a six-cup-a-day person, cut down to four cups a day in the first week, then two cups, then one.

5 Replace the caffeine with healthier drinks such as water, fruit juice and herbal teas. For an energy boost, replace chocolate with dried fruit, popcorn or cereal bars.