Monday, 20 August 2012

Key points


MENTAL HEALTH EFFECTS OF CAFFEINE



SUMMARY

  • People may not be aware that their mental ill-health may be being caused or exacerbated by their caffeine intake. In particular (a) anxiety is highly correlated with caffeine use, and (b) anxiety sufferers appear to often have high caffeine sensitivity.
  • People may also be over-estimating the benefits they are receiving from caffeine. Caffeine's perceived benefits may not be real, and it may have negative effects on personality, personal effectiveness and sleep quality.
  • Why not go caffeine free for 40 days (the first withdrawal days will not be fun) as a trial to find out?


RESEARCH: ANXIETY (incl. GAD, PTSD, panic disorder)
    Research: Summary
    • There is strong research support for association between caffeine and anxiety. E.g. http://www.ncbi.nlm.nih.gov/pubmed/21797659  "we selected eight randomized, double-blind studies where caffeine was administered orally, and none of them controlled for confounding factors in the analysis. ... The eight studies all showed a positive association between caffeine and anxiogenic effects and/or panic disorder."
    • The research base for improving mental health by stopping caffeine intake is almost non-existent, but is positive (see below). 
    Anxiety and caffeine use are often correlated
    1. 1996, "there is clinical and experimental evidence that acute caffeine can exacerbate the effects of an anxiety-inducing situation, or worsen an existing anxiety disorder, especially panic disorder." http://www.psychology.org.nz/cms_show_download.php?id=766
    2. 2008, "These findings support the hypothesis that individuals with PTSD would report higher levels of caffeine than individuals without PTSD." http://books.google.co.uk/books?id=xDNbBvYHAlkC&pg=PA21&lpg=PA21&dq=caffeine+ptsd&source=bl&ots=ALdzLLH_u0&sig=Mtn19vgHUwBcjV7Ft30sQbnGuzI&hl=en&sa=X&ei=JOELUMGDKcOw0QX3yaztCg&ved=0CE8Q6AEwATgK#v=onepage&q=caffeine%20ptsd&f=false)
    3. 2011, Literature review, "The 8 studies all showed a positive association between caffeine and anxiogenic [anxiety causing] effects and/or panic disorder.http://www.ncbi.nlm.nih.gov/pubmed/21797659
    Anxiety sufferers have high caffeine sensitivity
    1. 1985, "It appears that anxiety disorder patients have increased caffeine sensitivity"  http://www.sciencedirect.com/science/article/pii/0165178185900782
    2. 1988, "panic patients have increased sensitivity to caffeine", http://ajp.psychiatryonline.org/article.aspx?Volume=145&page=632&journalID=13
    3. 1992, "patients with GAD are abnormally sensitive to caffeine"   http://archpsyc.jamanetwork.com/article.aspx?articleid=495937
    4. 2007, "Our data suggest that there is an association between panic attacks, no matter if associated with PD or MDP, and hyperreactivity to an oral caffeine challenge test." http://www.ncbi.nlm.nih.gov/pubmed/17445520)
    5. 2010: 'Caffeine-induced anxiety is associated with a particular gene variant."  http://www.nature.com/npp/journal/v35/n9/pdf/npp201071a.pdf
    This is a key finding; some people feel ‘surely I am fine because I am only drinking 1-2 cups per day’, but this 'low' dosage may be very high for their sensitivity.

    For some people, anxiety can be very much reduced by coming off caffeine.
    1. 1989, of 24 cases of GAD or Panic Disorder, 5 ceased caffeine intake and 1 significantly reduced caffeine intake; all 6 (25% of the sample group) saw much reduced symptoms many months later, and 5 took no further medication. In addition, 3 of the 6 took caffeine on one subsequent occasion and all 3 immediately saw anxiety symptoms occur.  http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=4996824 
    2. ".... I had worked with several different patients who came to me having made no progress in getting their anxiety under control, no matter what was tried. They were often at a point of desperation. When I asked about their caffeine intake, almost without fail there was an unusual quantity of caffeine in their diet. .... But once these patients got their caffeine intake under 200mg/day—and most of them went off of it completely—their anxiety improved dramatically." Alison Lighthall, http://online.liebertpub.com/doi/pdfplus/10.1089/jcr.2011.1200
    3. Anecdotal testimonies, e.g. 
    http://blogs.psychcentral.com/panic/discuss/3270/
    On my GPs advice I slowly cut down then stopped my caffeine intake. My anxiety has decreased from being around 8/9 out of 10 every day to around 3/4 out of 10. This could be due to a few things but I believe that cutting caffeine out of my diet has had a major impact. The most positive thing I’ve done to reduce my anxiety ever!

    http://www.psychologytoday.com/blog/neuronarrative/201208/what-caffeine-really-does-your-brain-0/comments#comment-515252
    I am currently on month 7 of no caffeine (including chocolate)... It took me at least a month for my energy to come back to baseline and my motivation/focus is still slowly recovering. I haven't felt this good in years. My stress and anxiety levels are WAY down and I'm much more relaxed and calm around people.

    http://coffeefaq.com/site/node/11

    I am now 7 months clean, apart from 1 lapse 4 months ago.
    I definitely am way, way better than when on caffeine:
    1. GAD (generalised anxiety disorder) basically gone. finito. no more early hours high heart rate, sweating etc.
    2. energy level overall higher and much more even.
    3. thoughts and thinking better, more balanced, stronger (less garbled).
    4. personal relationships way better; less angry, aggressive.
    5. able to move onto other challenges and opportunities in life.

    See refs. in 'other people are exiting' section below, including http://coffeefaq.com/site/node/11  http://www.healthcentral.com/anxiety/c/8146/5936/coffee-anxiety 
    Rather than caffeine intake and mental illness being co-incident (for instance if caffeine is being taken as a stress reliever in a high stress environment, or as self-medication for mental illness), these examples show cessation of symptoms when caffeine intake is stopped, implying that caffeine intake is causal.

    Mental ill-health may not appear for a considerable period after caffeine intake begins. 
    1. We note that in the 1989 study referred to above, http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=4996824, in none of the cases had the onset of symptoms coincided with an increase in caffeine consumption.
    In general:
    1. 2012, "a trial of caffeine abstinence in cases of anxiety should always be encouraged"' Dr Malcolm Bruce (researcher; see 1989 above, NHS doctor).
    The US Diagnostic and Statistical Manual of Mental Disorders , known as the DSM-IV-TR includes four caffeine-related disorders: 
    • caffeine intoxication, 
    • caffeine-induced anxiety disorder, 
    • caffeine-induced sleep disorder, and 
    • caffeine related disorder not otherwise specified. 
    A fifth, caffeine withdrawal, is listed under the heading of "Criteria Sets and Axes Provided for Further Study." (http://www.minddisorders.com/Br-Del/Caffeine-related-disorders.html#ixzz2ItLcaa7f0)


    (Note: A possible thesis; anxiety is due to caffeine withdrawal, rather than caffeine use.
    This thesis correlates with; 
    (a) strong anecdotal evidence of anxiety being experienced during caffeine withdrawal, and 
    (b) some anecdotal evidence that some caffeine users experience anxiety on waking up (i.e. in early withdrawal having not ingested overnight), although this could be due to other affects, e.g. alcohol hang-over effects for users in a caffeine-alcohol using cycle.)


    OTHER CORRELATIONS OF HIGH CAFFEINE INTAKE AND HIGH MENTAL ILL-HEALTH

    See Articles on this blog on;
    • Psychosis/Schizophrenia
    • Finland
    • US Military
    • Suicide rates in Western European and North American countries

    OTHER MENTAL HEALTH EFFECTS
      "Increased public education about potential health problems related to caffeine consumption is suggested, and further controls of caffeine in psychiatric settings are recommended."   http://www.ncbi.nlm.nih.gov/pubmed/871104

      HIgh consumption of caffeine can itself produce effects similar to mental illness: 
      http://apt.rcpsych.org/content/11/6/432.full (the 3rd reply http://apt.rcpsych.org/content/11/6/432.abstract/reply# is also interesting) 
      http://www.livestrong.com/article/540592-caffeine-and-delusions/

      Mental ill-health effects can also be experienced due to other drugs which are being taken to counteract caffeine effects. For instance taking alcohol to dull the tension caused by caffeine; alcohol causes sleep disruption and depression.


      BENEFITS OF TAKING CAFFEINE ARE NOT AS GREAT AS BELIEVED

      "Consuming caffeine regularly does not appear to produce any net beneficial effects, based on the measures we examined.http://www.medicalnewstoday.com/releases/148623.php

      We believe that most people have wrong views about the benefits they are gaining from taking caffeine. They are not noticing that;
      • their morning 'fatigue and grumpiness' before drinking coffee are not due to personality or fatigue, but are symptoms of caffeine drug withdrawal (after abstention overnight). (e.g. http://www.forbes.com/sites/travisbradberry/2012/08/21/caffeine-the-silent-killer-of-emotional-intelligence/)
      • the initial brief feeling of relief from stress and anxiety is more than net outweighed by increased anxiety for many hours later on (which may also lead to alcohol ingestion)
      • the initial 'energy boost' and 'caffeine high' they used to feel when taking caffeine is reduced over the long-term, as their bodies habituate to the drug. 
      • their physical energy through the day can be very changeable, with very low energy periods. (Exhaustion can result from being in 'fight-or-flight state for long periods due to being highly caffeineated, and sleep can be disrupted; http://www.naturalnews.com/012352.html#ixzz28CrsiFk9. Doctor quote: "You can always tell who the coffee drinkers are: they're the ones who are tired all the time.")  They may also experience other physical aches and pains. 
      • Users may feel they are more productive, but actually are not; Caffeine does not lead to greater life effectiveness



      A good summary of caffeine's effects is:
      "I can’t ignore the energy boost and mental acceleration that comes from caffeine. 

      But I do notice negative side effects when I drink coffee. 

      Caffeine seems to make part of my brain overactive and another part underactive. I become really good at doing things, but very bad at prioritizing what needs to be done. If I drink a lot of coffee, I’ll often spend hours doing a bunch of low priority tasks, and I find that other unproductive habits are more likely to be done excessively. I become like a rat in a treadmill, doing more and more but not accomplishing what really matters. I find it very hard to focus on the big picture from a holistic whole-brain standpoint if I’ve consumed caffeine.

      I also feel that caffeine blocks too much of my intuition and creativity. I miss subtle sensory input, and my thinking becomes too linear. 

      Sometimes linear thinking is OK though. If I have a lot of menial tasks to complete, and I already have a clear to-do list to follow, drinking a cup of coffee can get me through them quickly. 

      But if I have to sit down and do high-level work like developing my next quarterly plan, caffeine will make a mess of my thought process and dramatically reduce my ability to concentrate. My mind races too much on caffeine; it’s hard to stay focused on just one thing.

      Additionally, caffeine definitely disrupts my sleep habits. Even if I have a cup of coffee in the morning and none for the rest of the day, I don’t sleep as well. I wake up in the middle of the night, or it’s hard for me to get out of bed in the morning. When I consume no caffeine, I sleep more restfully and wake up easily. I also don’t experience so much midday sleepiness."

      http://www.stevepavlina.com/blog/2005/05/how-to-give-up-coffee/


      Video: notice how by 3.30 she is speeding up.
      http://www.howtogeek.com/129212/the-effects-of-caffeine-video/#comment-199195



      MANY PEOPLE EXIT, OR TRY TO EXIT, CAFFEINE


      56% of caffeine users report a desire or unsuccessful attempts to stop or reduce usage, and 14% do stop. (Substance Abuse: A comprehensive textbook" Juliano, Anderson, Griffiths, 2011).

      See e.g.;
      Both 2012 US presidential candidates were non-caffeine-takers. (Whilst one can be cynical about politicians, people who achieve this role are probably relatively highly effective in some ways.)




      WITHDRAWAL

      WITHDRAWAL IS NOT EASY, BUT IS POSSIBLE
      Whilst withdrawal from caffeine is difficult and unpleasant, it is possible.

      A note on use of caffeine for self-medication.
      Many people take caffeine for self-medication; it may give a few precious minutes relief from their suffering. However in our view this is a lie; the net suffering, including the later anxiety that caffeine causes, outweigh the brief relief. Alternative self-medications, such as exercise, can be tried (see 'mindsets' below).

      Trigger motivations to withdraw:

      Factors that appear to finally trigger people to begin to attempt withdrawal are realisation and focus that caffeine is causing;

      • feelings of extreme fatigue, including feeling overtired upon waking in the morning (i.e. withdrawal from overnight non-caffeine).
      • increased anxiety; that exiting caffeine may reduce or stop my anxiety/GAD/panic disorder.
      • irritability, emotional highs and lows, and moodiness; personality impacts which are causing major hurt to me and to my loved ones.
      • poor quality of thinking; garbled and over-volatile.
      • day-to-day quality of life to be not as good as it could be; major damage to quality of life.
      • poor health; (a) body weight effects of milk/cream (if drink coffee that way), (b) teeth discolouring effects of coffee, (c) acne impact of caffeine.
      • being fed up of continual battling with caffeine, including lying to loved ones, needing to be covert about usage, etc..
      • lack of caffeine 'hit' as body now acclimatised to caffeine.

      Mindset suggestions for withdrawal include;
      • "timing: cease caffeine when it feels relatively right inside to do so; this may not be a logical time, but one when things just feel relatively right, when you feel right to 'catch the wave'. This may be for instance when you feel good and strong, or alternatively when you have been struck afresh by how much damage caffeine is doing to your and your loved ones lives.
      • the human brain is complex, and multi-faceted. Primitive drivers co-exist with rationality. Consciousness, and conscious determination, are only part of the story. This makes the 11th Commandment, Avoid Temptation, very important and powerful. Your human self can out-wit the primitive driver by not physically going near a coffee shop, meeting friends somewhere else, and not having coffee or coffee equipment in the home.
      • be aware this is a very fragile and subtle situation, and you could crack at any point
      • accept failures, and relapses, as stages in the learning journey; just accept, don't beat yourself up, and start again
      • vanity can be a strong motivator; think about whiter teeth, cleaner breath, no acne, being a nicer person!
      • do not say you are doing it for someone else; you have to do it for yourself
      • treat this as a withdrawal from addiction, e.g. http://www.spiritualriver.com/51-things-you-should-know-about-addiction-recovery/
      • consider using daily exercise (e.g. long runs, walks) (see no. 50 here; http://www.spiritualriver.com/51-things-you-should-know-about-addiction-recovery/)
      • you may hear yourself thinking lies, e.g. that you will have no energy, will die, etc; ignore; test it! think, even if so, I want to go through there
      • that you will remain in recovery, and at risk of temptation, for a lifetime."
      Advice for partners includes; 
      • "help him/her avoid temptation; make your own coffee when the user won't see, smell or hear it. when with him/her avoid even driving near coffee places. go someplace else for your trips.
      • do not react too much if his/her mood swings; anxiety, anger, fatigue, quiet, whatever; this is withdrawal, it will not last, just keep loving him/her.
      • don't criticise if he/she uses other drugs a bit more than usual in this phase e.g. alcohol, sugar.
      • find another hot drink he/she likes, e.g. fruit tea, and give it to him/her at the same times and as often or more often than he/she had coffee."
      Interestingly one therapist said to me; "some clients report perceived benefits of " coming off" high levels of daily caffeine and, I would say, even more often, their partners observe positive changes." It may be that caffeine users have poor self-awareness of the impact of the drug on them.

      Withdrawal methods:
      • Cold turkey seems the most common method. 
      • Some people reduce intake over a period before finally stopping. 
      • Using substitute drugs does not seem to help. 
      • An alternative counter-intuitive approach is to increase caffeine dosage - to 'blow out' so that you are well and truly sick of the stuff and what it does to your brain - before going cold turkey.
      • A possible route is to combine withdrawal with illness (cold, flu, etc); i.e. when you enter an illness, start withdrawal; this allows and enables you to be 'wiped out', in bed, and socially and professionally unavailable. It also gives great support from family, makes it easier to avoid temptation, enables you to associate caffeine with catching the illness (i.e. 'yeughhh' when think of caffeine) and enables you to 'mentally mix up' some caffeine withdrawal symptoms within the illness (i.e. 'I'm not sure and I don't care what is causing this headache.'). (This method can be used also to simultaneously detox i.e. withdraw also from alcohol, chocolate, pain-killers, sugar, cheese, wheat.)
      • It can be helpful to also exit other drugs (e.g. alcohol); you may be in a negative loop where alcohol leads to caffeine, which leads to alcohol. This may be done at the same time. Phasing is less likely to succeed.
      • Meditation can be very helpful, as it can raise your underlying happiness set point.

      Techniques for during withdrawal

      1. It can be a good idea to write down 
      • your motivation reasons, (e.g. "Nice life ruined by caffeine.")
      • what you are expecting during withdrawal (e.g. see the effects listed below),
      • and set up a system that will regularly remind you of these as you go through withdrawal (e.g. put it up where you can see it each day (e.g. bathroom mirror), or send it in an email or imaginary meeting title to yourself once or several times a day).
      Anxiety may be reduced by taking paracetamol/tylenol/acetaminophen (http://en.wikipedia.org/wiki/Paracetamol#Psychological_effects).

      Anxiety and despair may be reduced or eliminated by Socratic dialogue / REBT (Albert Ellis); asking yourself what exactly is distressing you, until you reach a real reason (not just 'it might be awful'); often the real reason is actually manageable. e.g. 'It would be nice if my wife did not leave me, but it would actually not be the end of the world - life would carry on.'

      2. In contrast other people do not want to be reminded about anything to do with caffeine, as this brings temptation; they would rather try to 'break clear', and have no reminders of caffeine or other baggage as they attempt to achieve escape velocity.


      Common withdrawal experiences:

      PHASE 1; Days 1-4
      - bad headaches for 1-4 days
      - feelings of strong anxiety, fear, despair and uncertainty for c.5 days; i.e. anxiety (GAD) goes up in the early stages of withdrawal. It is important to be ready for these feelings, and to be able to see through them (including being in a life situation for those days where you can do so (on your own?).
      - exercise, possibly very long and intense, can help in this phase.


      PHASE 2; Days 5-6
      - headaches may still be present, but now easing
      - feelings of strong anxiety, fear, despair and uncertainty may still be strong.
      - possible high emotional volatility on days 5-6. Can feel very good, in an unsustainable way, on day 6.

      For some people withdrawal is essentially complete by day 6. 

      However other people see a much longer period of withdrawal symptoms.

      PHASE 3: Days 7-14
      - feelings of strong anxiety, fear and uncertainty can be volatile with strong 'hits' for days 6-14
      - exercise, possibly very long and intense, can help in this phase.
      - in this phase there can be surprising folds, e.g. from thinking 'I've cracked it, so why not?', or slip-ups of habit; vigilance is required.

      PHASE 4: Long-term
      - possible various physical aches and pains, for 30-90 days
      - possible sleep disruption, for 30-90 days
      - very strong temptation at times for c.40 days
      - possible low/flaky energy for maybe up to 70 days (operate in 'float', 'blind way', without needing the 'inner visibility check' of energy level that caffeine gives)
      - feel very, very good, when withdrawal is advanced. E.g. "I've been off caffeine for 30 days and feel better mentally and physically than I have since high school." http://coffeefaq.com/site/node/11


      PHASE 5; Rest of Life
      - possible continual temptation for a lifetime (see below).

      For more on withdrawal methods;

      Beware 'hidden' caffeine 
      Note that decaff coffee is still significantly caffeinated.   http://www.sciencedaily.com/releases/2006/10/061012185602.htm
      Other sources of caffeine are energy drinks, cola's, chocolate, non-cola soda, guarana, 'energised' oatmeal, weight-loss pills, pain relief pills, breath fresheners, etc. (see http://health.yahoo.net/articles/nutrition/photos/12-surprising-sources-caffeine#0, and our links page).
      Read the labels of what you are ingesting!


      STAYING CLEAN

      Relapse can occur after long periods of being clean (e.g. Philip Seymour Hoffman). 
      You need to 
      1. remain vigilant, and 
      2. remain a long way, mentally, from caffeine.

      Characteristics of relapse.
      Dangerous moments may include
      - periods of low energy
      - periods of high stress
      - dull periods of life, when 'nothing is going on'.

      "... very good question about why I went back onto it ! If I’m honest, it was because I wanted the buzz and thought it would be different this time – despite having been through this cycle a number of times before and knowing deep down it wouldn’t be different at all. I am in recovery from other (some would say more “serious”) addictions using a 12 step programme; in my experience caffeine addiction involves the same behaviours and challenges, although nowhere near the same severity of consequences.

      This is partly behind my comments about withdrawal and severity of it below. Let’s be honest, this isn’t alcoholism or addiction to hard drugs, legal or otherwise.


      With recovery, I find there’s a constant battle between the addict (“one won’t hurt”, “this time it’ll be different”, “everyone else is doing it” etc.) and the true, rational, logical voice (“it always makes me feel ill”, “it’s just an addiction”, “it won’t make me feel better” etc.). If I don’t keep reminding myself of the truth of the situation and/or if there is the wrong combination of circumstances – I’m feeling particularly bad (or sometimes good), tired, fed up etc. - then I think “what the hell” and persuade myself I’ll just have one and it will be OK. One is all it seems to take for me to be back on it and before I know it I’m a few weeks down the line, feeling exhausted and depressed, banging my head on the wall and asking how I fell for it again !


      So the short version of how not to relapse is take it one day at a time and don’t forget the consequences. Don’t think of the one coffee (or whatever) you’re planning, think through the full scenario and where it will end up. Anyway, I shall be going cold turkey again over the Christmas holidays, hopefully for the last time (a day at a time….)."


      Beating temptation - fight cleverly, use your advantage, use 'precommitment'.
      We are not strong enough to beat our inner 'monkey man' in a straight fight, e.g. if temptation is there right in front of us. (We are continually surprised and perplexed that all our conscious logic and settled determination proves absolutely worthless in these situations. Addiction is genuinely difficult.).

      However 
      - our 'monkey man' works on a very short-term focus; he/she is only aware of what is right in front of him/her. 
      - we can think more strategically and further ahead than our inner monkey man. This can include taking deliberate actions to avoid temptation confrontation occuring, e.g. 
      1. having no coffee or coffee making kit in the house, 
      2. taking a walking or driving travel route that keeps us well away from the coffee shop,
      3. leaving home late so that there is no time to queue for a coffee at the coffee shop. 
      4. keeping lying to the monkey man, e.g. keep on promising the monkey man that you will have coffee soon, but then avoiding by walking or driving a way that does not go past a coffee shop
      5. distracting our mind by keeping thinking about other things, e.g. topics that fascinate and interest us. 
      6. reminding yourself that you are sick to death of life, and that nothing is important; even caffeine.
      In other words we can use 'precommitment'.

      This situation can feel like you are continually very, very close to temptation, and yet you remain clean. It may be that being so close to caffeine reassures your monkey man (that caffeine is there if a crisis occurs), and somehow enables temptation survival. An extreme tactic might be to actually carry coffee with you (say in a flask) but not drink it.

      Successful sustained withdrawal may need stopping other drugs also e.g. alcohol.
      Testimonies show that some/many people find that to achieve sustained withdrawal may need withdrawal from other brian-barrier drugs e.g. alcohol, chocolate, maybe even sugar, etc..
      Having a 'clean' brain;
      (a) reduces temptations and up/down experiences, which means that both the needs and weakness opportunity for taking caffeine are reduced, 
      (b) gives very positive feelings of clarity, cleanness and happiness, that add to motivation to stay clean
      (c) enables progress on life in general, which again also adds to motivation to stay clean.

      Successful withdrawal needs accepting, and getting used to, being different
      As users progress in withdrawal they may be uncomfortable at new feelings, such as
      - health
      - increased sensitivity to things
      - the sensation of being happy
      - the sensation of being more human, and thus weak perhaps
      - the sensation of being vulnerable, as the 'nastiness' of caffeine, that protected them, is taken away
      - the sensation that they are different, and thus may be less able or effective in what they do in their lives.
      It is important to accept that 
      - life will feel different
      - you will be different
      - the new ways of feeling will not cause collapse or damage. They will not destroy you.

      There may even need to be a 'mourning' process, in which you say good bye to old ways of being, and face a different world.

      Successful withdrawal needs breaking links with usage
      There may be habits and people that will tend to drag you back to using; they need to be forcefully managed or avoided. It can take some time before it is safe to visit a coffee shop for a cup of tea with a friend or loved one, but alternatively it may be wise to do that soon, to break the association of those happinesses with caffeine.

      Staying clean long-term
      Ex-users will remain vulnerable to temptation, as with any addict. 

      Relapse can occur after long periods of being clean (e.g. Philip Hoffman). 

      Chip Summers of Focus 12, rehabilitation charity (used heroin for 18 years. clean for 29); BBC Derbyshire, 3/2/14, http://www.bbc.co.uk/programmes/b03szmgx  
      "This is the dilemma faced by every addict who gets into recovery.
      Getting out of the substance is easier that they thought it would be
      The problem is dealing with the person who is left behind, without drugs which they probably used, as I did, to cover up difficult emotions, low self-esteem, things like that.

      We forget what it was like when we made the decision to be abstinent... that our life was in hell. 
      But we quite quickly forget what was the consequences of our using,
      quite soon we have a slightly distorted memory of it,
      and that's why you have to be vigilant, you have to keep on your guard,
      because you can let little things creep in,
      and if you let little things creep in they will gradually build up to bigger things.
      We have to be vigilant if we want to be free of dependence.

      'You have to keep on remembering what got you to the decision to be clean, and keep on remembering that.
      I remember, on a daily basis, bring up a few mental photographs of how life was, as a heroin addict, every day. However hard life may be, it's nothing compared to being on heroin.'

      'Your tolerance has been completely disordered.'

      Prescription drugs (e.g. codeine-based, 'that give some comfort, a bit of a security blanket') can easily lead to other drugs.



      DISCLAIMER

      This site expresses personal opinions only, in some cases with supporting links and in some cases not. These opinions should not be taken as factually correct, or be relied upon, used or otherwise acted upon in any way. No liability will be accepted for any results of reading or other use of this website.

      Suicide rates correlation with coffee consumption


      We note a general correlation between coffee consumption and suicide rates in Western European and North American countries (sources, http://en.wikipedia.org/wiki/List_of_countries_by_coffee_consumption_per_capitahttp://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate#cite_note-1)




      South Korea has the highest suicide rate in the OECD (http://en.wikipedia.org/wiki/List_of_OECD_countries_by_suicide_rate), having more than doubled from 1999 to 2009 (http://www.bbc.co.uk/news/world-asia-pacific-14784776).
      South Korean coffee consumption did not appear relatively high in 2009, at 1.8kg per person p.a. (http://en.wikipedia.org/wiki/List_of_countries_by_coffee_consumption_per_capita)., having grown strongly in the 1980s (http://blog.wolframalpha.com/category/socioeconomic/). South Korea's tea consumption was also not relatively high (http://en.wikipedia.org/wiki/Tea_consumption). (It is not known if South Koreans tendency to drink vending machine coffee (http://davidreport.com/201202/coffee-korea/) effects coffee consumption data).
      There has been a 10x increase in the number of coffee shops from 2006 to 2011 (http://in.reuters.com/article/2012/08/21/uk-korea-coffee-idINLNE87K00O20120821). This may imply that overall coffee consumption has increased markedly since 2009.

      If South Korea's coffee consumption has risen after the increase in suicide rate, this may imply that coffee's relationship with suicide rates is not causal, but co-incidental.

      Movements in Japan's suicide rate (http://upload.wikimedia.org/wikipedia/commons/0/05/Suicide-deaths-per-100000-trend.jpg)
      do not correlate with the big increase in 1970-85 in coffee imports (although coffee may have replaced other caffeine sources e.g. tea, and there may have been a co-incident reduction in social norms of suicide) (http://www.google.co.uk/imgres?hl=en&sa=X&tbo=d&rlz=1C5CHFA_enGB506GB506&biw=2560&bih=1155&tbm=isch&tbnid=NpWweScHxjJm2M:&imgrefurl=http://paradisocoffee.blogspot.com/2010/11/chinas-coffee-market-waiting-for.html&docid=xpchXwzIsm5YbM&imgurl=http://3.bp.blogspot.com/_cgv3vP_vnSw/TNhTXdjN7XI/AAAAAAAAAAM/FVsD2Ls6cww/s1600/KeijiOhta_%2525E9%2525A1%2525B5%2525E9%25259D%2525A2_03.jpg&w=1600&h=1237&ei=W40XUcjELOuZ0QXOuoHIBg&zoom=1&ved=1t:3588,r:25,s:0,i:166&iact=rc&dur=493&sig=104730183005075819911&page=1&tbnh=167&tbnw=254&start=0&ndsp=54&tx=172&ty=76)



      80% or more of suicides have a mental health component.





      Monday, 30 July 2012

      US Military personnel in combat; High mental ill-health? and high caffeine intake?

      Recent media coverage has noted apparently high prevalence of mental ill-health (PTSD, depression, suicide) among US Military personnel who have been in combat situations.



      Consumption of caffeine by US military:

      1. Appears high;

      (a) in absolute terms

      Studies have shown average consumption levels among US Military personnel, not in combat, of:
      We suspect that military caffeine consumption may be much higher than these levels in combat situations due to (a) higher desired performance level, (b) higher stress, and (c) actual or anticipated sleep deprivation.
      (b) relative to average US consumption

      Measures of US average adult consumption have been between 120-250mg,
      http://www.foodinsight.org/Resources/Detail.aspx?topic=Fact_Sheet_Caffeine_and_Health
      http://www.sciencedirect.com/science/article/pii/S0278691504001589
      http://www.ncbi.nlm.nih.gov/books/NBK3985/table/a20015f31ttt00015/?report=objectonly
      http://www.ehowspace.com/how-much-caffeine-is-consumed-by-the-average-person.
      This 2004 study found, on average, caffeine consumers’ intakes were 193 mg caffeine per day (the average for the entire population would be lower as c.10% of the population do not consumer caffeine). http://www.sciencedirect.com/science/article/pii/S000282230401702X

      We believe current average consumption may now be higher, due to larger and stronger coffee servings, and growth of energy drinks and other caffeine sources. However we believe average levels probably remain below the military levels mentioned above, and particularly below likely combat usage.


      2. May have risen in recent years

      It seems likely that military personnel caffeine intake has increased in recent years, given
      The Army appears to have little sense of restraint or health concern in usage of caffeine by soldiers.
      http://www.aolnews.com/2010/11/30/military-looks-at-ways-to-give-soldiers-caffeine/


      (We also note recent increases in use by military personnel of prescription drugs, particularly pain-relievers (as downers after high caffeine use?); http://www.whitehouse.gov/sites/default/files/ondcp/newsletters/ondcp_update_february_2010.pdf)


      3. Further observationsAlison Lighthall, 
      http://online.liebertpub.com/doi/pdfplus/10.1089/jcr.2011.1200



      DISCUSSION


      Other facts may explain this correlation;
      •  past mental ill-health prevalence may have been equally high, but undiagnosed (although the measure of suicide rates appear higher)
      •  recent combat situations may have carried different stresses than those in the past. The goals may be more complex, and the enemy not easily identified or attacked (although these factors also applied to some previous conflicts)
      • caffeine may be being consumed as self-medication for mental ill-health caused by other factors.
      • use of other drugs by the US military has also increased strongly in recent years (e.g. ' there has been a 700% increase in the number of psychoactive drugs — antipsychotics, sedatives, stimulants and mood stabilizers — prescribed to our troops between 2005 and 2011 — despite a steady reduction in combat troop levels since 2008.' Richard Friedman, http://www.nytimes.com/2013/04/07/opinion/sunday/wars-on-drugs.html?ref=opinion&_r=2&)
      We should not expect a direct correlation between caffeine dosage and illness in individual cases, as some people are very sensitive to caffeine, and thus may not need a huge dose to be effected.

      However in our view it is strongly worth investigating whether caffeine is a key causal or exacerbating factor - and whether caffeine cessation would, after the withdrawal phase, reduce US military mental health suffering. 





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