The World of Caffeine (56 page)

If asked to explain the nature of a drug of abuse, many people might answer, “I may not be able to define a drug of abuse, but I know one when I see one.” Consideration of patterns of drug use in other societies, however, may disturb such comforting smugness. As we saw in the Yemen, for example, the plant khat, which contains a very powerful stimulating, habituating, and intoxicating drug, is brewed into tea, much in the way we use caffeine, and is used by the great majority of both children and adults. Outside observers have frequently assumed that khat is a drug of abuse and that the Yemeni population suffers from an addiction problem, similar to Western problems with heroin and cocaine, that should be addressed by every available educational, social, and legal countermeasure. Most people who live in the Yemen, however, do not share this opinion. The same question arises for us in relation to caffeine: If an entire society accepts a pattern of drug use, is that use, by definition, a normal one?

Researchers attempting to determine whether caffeine should be branded a drug of abuse have suggested that the word “addiction” be restricted to those conditions in which physical dependence and clinical dependence syndrome both obtain. Hirsh asserted that an addictive drug was one that engenders a “compulsion” or “an over-whelming involvement that pervades the total life activity…to the exclusion of all other interests,”
¹⁵
and concluded that caffeine, like other methylxanthines, was not addictive. R.R.Griffiths and colleagues have argued that to qualify as a drug of abuse a substance must have
both
reinforcing effects
and
produce harmful effects on the user and the society. Caffeine’s reinforcing effects make it a candidate to be considered as a drug of abuse, but, Griffiths cautions, its classification as such must await a fuller appraisal of its possible deleterious effects.
¹⁶

Photograph of Russian brick tea money. (Courtesy of Chase Manhattan Archives)

Photograph of Russian brick tea money. (Courtesy of Chase Manhattan Archives)

Looking at the question from a different angle, we note that the remorseless metabolic and psychical demand for certain intoxicants combines with their portability to enable them to function as money in a black market. In fact, one hallmark of a psychoactive drug of abuse, therefore, is a history of its use as a medium of exchange. Opium, for example, is as good as money among black-market traders in Southeast Asia. Cocaine is like gold bullion to the cartel managers of South America. Similarly, caffeine-rich seeds, beans, and processed leaves have frequently served as mediums of exchange throughout the world. In some African countries, cola nuts are still used as money, the way the Maya, and other South Americans until the eighteenth century, used cacao beans. In China and Russia, dried tea leaves were pressed into bricks and used as currency. In Egypt and elsewhere among the Moslems, coffee was used as tender in the marketplace from the beginning of the sixteenth century.

Many consumers of coffee, tea, and cola, never having entertained an association between caffeine and drug use, may be surprised to learn that the massive modern catalogue of psychiatric problems, the
Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV),
includes an entry for “Caffeine Intoxication,” which it describes either as an acute drug overdose condition, occurring after the ingestion of a large amount of caffeine, or as a chronic condition, otherwise known as “caffeinism” or “caffeism,” associated with the regular consumption of large amounts of caffeine.

There is nothing new about the awareness of caffeine intoxication, for it has been well described as a psychiatric disorder for more than a hundred years. Yet despite long-standing recognition, which perhaps began with the coining of the Arabic word
“marqaha”
or “caffeine high,” in the sixteenth century, there is, even today, little information available about its prevalence or incidence.

In 1896 J.T.Rugh
¹⁷
reported the case of a traveling salesman who had resorted to excessive coffee consumption to maintain an intense pace of work and was troubled by nervousness, involuntary contractions in the arms and legs, a sense of impending danger, and sleep disturbance. Similar reports of caffeine intoxication first appear in medical literature from the middle of the 1800s, and the profile of common symptoms remains unchanged today. The most common are anxiety or nervousness, insomnia, gastrointestinal disturbances, irregular heartbeat, tremors, and psychomotor agitation. Other reported symptoms include excessive urination, headaches, diarrhea, and irregular breathing.

An interesting and unusual case was reported to
JAMA
early in 1914 by Otis Orendorff, M.D., of Canon City, Colorado. “A young miss, 18, an office clerk, of a slight, frail physique, had ordinary symptoms of asthenopia [eyestrain] for four years,” Orendorff wrote. She grew worse over a period of several months. Although tests were administered and full correction for her vision was provided, she experienced no relief. The patient was alternately exhilarated and depressed. She had memory lapses and maintained a “deportment with an indifference to the usual conventionalities and proprieties.” She had intermittent headaches, apparently not caused by work, but that increased when she attempted to read. She had insomnia at night but fell asleep at work. Her condition was getting serious. The physician was at his wits’ end, when the patient asked him “if there could be any danger in an overindulgence of Coca-Cola? stating that she drank from three to six glasses a day. In addition, she had two or three cups of strong coffee at mealtime, sometimes taking but little other nourishment.” He reports prompt improvement on curtailing her daily caffeine ingestion, concluding, “I feel that such a case is of interest from an ophthalmologic point of view and also because it indicates that the profession should be more alive to the pernicious influence in habit formation of some of the popular beverages served to young persons at public ‘slop’ fountains.”
¹⁸

Unknown to the typical coffee or tea drinker, there exists a subterranean culture of undetermined extent in which caffeine is consumed with the fixed intention of inducing intoxication. That is, many people across the country and around the world regularly use large doses of caffeine to get high. In doing so, they frequently encounter many of the symptoms of toxicity, somatic and psychological, that we discuss in this

chapter. (See
Appendix B
,
table 5
, for the diagnostic criteria for caffeine intoxication from the
Diagnostic and Statistical
Manual of Mental Disorders
.)

Internet news groups are electronic confraternities in which people who have generally never met each other post public messages, photographs, and even sound files pertaining to a common interest. If you access such newsgroups as “alt.drugs.caffeine” or “alt.coffee” on any given day, you are certain to find questions, comments, confessions, misgivings, and boasts regarding the use of large amounts of caffeine. Here are quotations from Internet postings, which are rife with misinformation and misspellings:

Q: What are some of the affects you’ve experienced when you suck down too much caffeine?

A: I actually seem to get less alert. Well, actually the only effect I get from overdosing on caffeine is severe nausea and vomiting. Man, I just go numb in my hands and feet and start shaking all over, as my mind and body go hyper. I can’t focus, can’t think straight. I go through oscillating emotional states, and I experience cold sweats, shaking, and sometimes tachycardia. I usually have oscillations from paranoid to psychotically calm and back again, along with racing thoughts, while getting slight muscle cramps.

A friend of mine snorted pharmaceutical grade caffeine once; he said it was extremely harsh on the nasal lining and not worth the buzz.

Q: I know a guy who once smoked a teabag and he claims that it gave him a buzz. Does anybody know if what he said is true?

A: Yes it works, i did it in england with the cheap tea they give you in a generic (low end) hotel, you just unfold the tea bag, you roll it up into something resembling a joint, and you light it, it is next to impossible to keep it lit though. oh it is the caffiene in it that gets you buzzed, the problem is that it goes away after about an hour and it leaves you with a bitch of a headache and some really bad cotton mouth.

• • •

It is clear that scientists have little hard data on which to base conclusions about the prevalence of caffeine intoxication. The uncertainty is exacerbated by the failure of some researchers to distinguish between chronic high caffeine consumption and caffeine intoxication, or similarly, the failure to distinguish between an isolated episode of caffeine intoxication and chronic intoxication. Because caffeine is the most widely used drug on earth, we can be sure that, sooner or later, both the prevalence and incidence of caffeine intoxication will be better characterized by applying the rigorous criteria for diagnosis, standardized assessments, and representative sampling techniques that have been applied to intoxicants such as alcohol, cocaine, and morphine.

Really
heavy caffeine consumption has often been observed among institutionalized schizophrenics, as this curious letter, captioned “Coffee Eating in Chronic Schizophrenics,” from two psychiatrists to the
American Journal of Psychiatry
(July 1986) vividly attests: