editorial comment Wake up and small the lawsuit coming.....

Mark Nicholson considers himself a recovered drug addict of sorts. His addiction?

"Coca-Cola," he says.

Or more precisely, the caffeine spike in every can. The 51-year-old Idlewylde, Maryland, nurse spent years stashing sodas in his car, in his hospital locker, even by his bed. It was frequently the last thing he drank at night, the first when he awoke.

If he didn't get his fix, he paid: "I'd get this humongous headache and feel like I was going to throw up."

Nicholson ultimately kicked the caffeine habit with help from a little-known Johns Hopkins Hospital program for people hooked on the drug.

But latte lovers, chocoholics and other caffeine junkies take heed: While this particular case may sound extreme, mounting scientific evidence shows that jokes about caffeine withdrawal are no joke at all - and it doesn't take much to get hooked.

"Some people say it's all in your head," says Roland Griffiths, a caffeine researcher at the Johns Hopkins School of Medicine in Baltimore, Maryland. "We're able to show, based on a number of rigorous studies, that it's real and biological."

In the most comprehensive survey of caffeine withdrawal research to date, Griffiths and a colleague pored over 170 years of studies and concluded that one small cup of coffee - only 100 milligrams of caffeine - is all it takes to trigger symptoms that include headaches, fatigue and irritability.

For serious caffeine junkies, going cold turkey can be even more traumatic. The latest analysis, published last month in the journal Psychopharmacology, found that some experience flulike symptoms such as muscle pain, nausea and vomiting when they go off caffeine. Thirteen percent of people weathering withdrawal have to call off work or cancel daily chores.

Some psychologists are even pushing the American Psychiatric Association to classify caffeine withdrawal as a bona fide mental disorder in the next edition of its Diagnostic and Statistical Manual of Mental Disorders.

If that happens, it will likely be due in part to Griffiths.

The 58-year-old psychologist is regarded as one of the country's leading investigators of caffeine and its effects.

Legal and generally safe, caffeine is the most popular mind-altering drug in the world, consumed by 80 percent of Americans. That fact alone made it worth investigating, says Griffiths, who became interested in the drug in the 1980s.

As a researcher who also studies nicotine, cocaine and other, often-abused drugs, he also realized that caffeine might be a good model for analyzing the addiction process. "It's not cocaine," Griffiths explains. Yet "it controls behavior."

Just how much remains hotly debated. The American Psychiatric Association doesn't recognize caffeine as a drug that causes dependence. But Griffiths says anybody who requires convincing need only hang out at a Starbucks some morning - as Griffiths has done - to watch the regulars roll in like clockwork.

"People get dependent on caffeine," says Griffiths. "The question is: How does the drug do that? What kind of biological mechanism is it hijacking? It becomes this really interesting puzzle to figure out what's going on."

Once consumed, caffeine acts quickly. "This means that, soon after you finish your cup of coffee or tea, caffeine will be present in virtually every cell of your body," Bennett Weinberg and Bonnie Bealer note in "The World of Caffeine: The Science and Culture of the World's Most Popular Drug."

Griffiths' research has shown that people begin to feel caffeine's mood-altering effects after ingesting as little as 10 milligrams.

"Just a sip of coffee," he says.

The drug disappears quickly - typically within 12 hours to 24 hours. This, says Griffiths, explains why coffee is so often a morning ritual: "People are actually waking up in withdrawal." Griffiths and other caffeine researchers insist that they have nothing against the drug, which has undoubtedly saved lives and careers by helping drowsy drivers, soldiers, aviators, students and machine operators stay awake. Recent research even hints that caffeine helps protect against gallstones and Parkinson's disease.

"You don't loose your job, your friends, or your money by taking caffeine," says American University psychologist Laura Juliano, who collaborated with Griffiths on the latest review of withdrawal research.

"That's not to say that people don't do pretty extreme things sometimes to get it," she adds.

Some caffeine users want to stop but can't. To understand why, Griffiths launched a program to study and treat caffeine dependence in 2001. His little-publicized clinic may be the only one of its kind in the nation.

A recent graduate is Lynda Davis, a 38-year-old Linthicum, Md., social worker who used to pick up a 20-ounce coffee on her way to work every day. Although she loved the taste, she began to worry that coffee was staining her teeth and making her cranky.

She repeatedly tried to quit. But gave up each time after experiencing splitting headaches. "I would have to take Advil around the clock," she recalls.

Brian Richards, the Hopkins psychologist who runs the caffeine clinic, says Davis' response is typical. So the goal of the caffeine dependence program is to cut back consumption gradually over several months to avoid withdrawal symptoms.

The 59 people enrolled in the program keep a diary of caffeine use and have monthly sessions with a therapist. Saliva tests help determine if they're sticking to the program.

For many, the program works. Nicholson, the Idlewylde nurse, says he's been clean for two years and now guzzles only caffeine-free Coke. "The only thing I take with caffeine now is an occasional piece of chocolate," he says.

But some people find they can't - or don't want to - quit. Griffiths isn't surprised. After all, he says, there's a reason why caffeine has been popular in so many cultures over the centuries. "It's a great drug," he says.

For more information about the Johns Hopkins caffeine program, visit: www.caffeinedependence.org.




By Michael Stroh The Baltimore Sun

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