A problematic pattern of caffeine use leading to clinically significant impairment or distress, as manifested by at least the first three of the following, occurring within a 12-month period:
- A persistent desire or unsuccessful efforts to cut down or control caffeine use.
- Continued caffeine use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by caffeine.
- Withdrawal, as manifested by either of the following:
- a. The characteristic withdrawal syndrome for caffeine.
- b. Caffeine (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
- Caffeine is often taken in larger amounts or over a longer period than was intended.
- Recurrent caffeine use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated tardiness or absences from work or school related to caffeine use or withdrawal).
- 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).
- 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.
- A great deal of time is spent in activities necessary to obtain caffeine, use caffeine, or recover from its effects.
- Craving, or a strong desire or urge to use caffeine.
Nonproblematic use of caffeine
The distinction between nonproblematic use of caffeine and caffeine use disorder can be difficult to make because social, behavioral, or psychological problems may be difficult to attribute to the substance, especially in the context of use of other substances. Regular, heavy caffeine use that can result in tolerance and withdrawal is relatively common, which by itself should not be sufficient for making a diagnosis.
Problems related to use of other stimulant medications or substances may approximate the features of caffeine use disorder.