If you can't get by without caffeine and won't give it up even if you have a condition that may be impacted by it, such as pregnancy, a heart condition, or a bleeding disorder, you may have "Caffeine Use Disorder." 

Caffeine is the most commonly used drug in the world, according to the authors of a new paper, and is found in everything from coffee and soda, to OTC pain relievers and a bunch of stuff with some form of the word "energy" on the label, but they say health professionals have been slow to characterize problematic caffeine use and acknowledge that some cases may call for treatment. 

So if you joke that "Caffeine isn't a drug, it's a vitamin" you may have a condition.  

"The negative effects of caffeine are often not recognized as such because it is a socially acceptable and widely consumed drug that is well integrated into our customs and routines," said American University psychology professor Laura Juliano. "And while many people can consume caffeine without harm, for some it produces negative effects, physical dependence, interferes with daily functioning, and can be difficult to give up, which are signs of problematic use."    

They review previously published caffeine research to find biological evidence for caffeine dependence, data that shows how widespread dependence is, and the significant physical and psychological symptoms experienced by habitual caffeine users. Juliano and coauthors also address the diagnostic criteria for Caffeine Use Disorder and outline an agenda to help direct future caffeine dependence research.

The American Psychiatric Association recognized Caffeine Use Disorder as a health concern in need of additional research in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), which used by mental health professionals in the United States but is no longer considered valid by The National Institute of Mental Health (NIMH).

"There is misconception among professionals and lay people alike that caffeine is not difficult to give up. However, in population-based studies, more than 50 percent of regular caffeine consumers report that they have had difficulty quitting or reducing caffeine use," said Juliano, who served as an appointed advisor to the DSM-5 Substance Use Disorders work group and lobbied for Caffeine Use Disorder inclusion. "Furthermore, genetics research may help us to better understand the effects of caffeine on health and pregnancy as well as individual differences in caffeine consumption and sensitivity." 

A Lack of Labeling

Based on their review, the authors advise that healthy adults should limit caffeine consumption to no more than 400 mg per day — the equivalent of about two to three 8-oz cups of coffee. Pregnant women should consume less than 200 mg per day and people who regularly experience anxiety or insomnia, as well as those with high blood pressure, heart problems, or urinary incontinence, should also limit caffeine.

But limiting one's caffeine intake is often easier said than done as most people don't know how much caffeine they consume daily.

"At this time, manufacturers are not required to label caffeine amounts and some products such as energy drinks do not have regulated limits on caffeine," Juliano said, adding that if this changed, people could perhaps better limit their consumption and ideally, avoid caffeine's possible negative effects. "Through our research, we have observed that people who have been unable to quit or cut back on caffeine on their own would be interested in receiving formal treatment—similar to the outside assistance people can turn to if they want to quit smoking or tobacco use."