Caffeine Addiction

What is Caffeine?

Caffeine is a naturally occurring stimulant commonly found in coffee, tea, cocoa, chocolate, cola-flavoured soft drinks etc. It is referred to as a stimulant because it increases the body’s state of arousal by facilitating the production of nerve impulses which increase brain activity.

Caffeine was first isolated from coffee in 1821 and originated from Ethiopia.

How is Caffeine consumed?

Caffeine is taken orally in drinks such as coffee, tea, energy drinks, a constituent of some over-the-counter medicines and as a food in chocolate bars. Also, it comes in formulated tablets which are used to increase alertness. (Prevention Directorate, 2006)

What are the recommended amounts?

The U.S. Food and Drug Administration considers 400 milligrams (about 4 cups brewed coffee) a safe amount of caffeine for healthy adults to consume daily. However, pregnant women should limit their caffeine intake to 200 mg a day (about 2 cups brewed coffee), according to the American College of Obstetricians and Gynaecologists.

The American Academy of Paediatrics suggests that children under age 12 should not consume any food or beverages with caffeine. For adolescents 12 and older, caffeine intake should be limited to no more than 100 mg daily. This is the amount in two or three 12-ounce cans of cola soda. (Harvard T.H. Chan, School of Public Health, 2020)

What are the health effects of Caffeine?

Caffeine can have some health benefits although not all are confirmed by research. The effect varies from person to person depending on certain characteristics.

• Individual – weight, gender, mood/personality, previous caffeine experience, drug expectations, taking it with or without food
• Drug – quantity, dose, how it is prepared and consumed
• Setting – Reason for use e.g. To stay alert, for studying

Short term effects

One – two cups of average-strength coffee can elicit mild effects such as:

• Increased alertness and energy
• Alterations to mood
• Increased metabolism
• Elevated blood pressure
• Increased body temperature
• Increased urination
• Increased gastric acid secretion.

The effects of caffeine in large doses (i.e., more than 600mg or eight average cups of coffee) include:

• Headache
• Hand tremors
• Nervousness
• Diarrhoea

Very large doses (10g or more) can produce high blood sugar.

Long-term effects

Regular use of more than 600mg of caffeine per day may cause:

• Chronic insomnia
• Depression
• Stomach upset
• Persistent anxiety
• Heart palpitations

What is Caffeine Addiction?

In most cases, drinking Caffeinated beverages is a relatively safe and non-harmful habit; however, when the need for Caffeine crosses the line from a pleasant pick-me-up to a daily necessity, addiction is possible.

Some terms to understand:

• Tolerance - This means that a person needs more of the drug(caffeine) to achieve the same effects they did previously with smaller amounts.
• Dependence - This occurs when someone finds it very difficult to stop or reduce their caffeine consumption.
• Withdrawal - Withdrawal occurs when someone who is dependent on caffeine decides to cut down or stop using it. Symptoms include:
  • Severe headaches
  • Poor concentration
  • Flu-like symptoms
  • Irritability

These symptoms usually begin 12 to 24 hours after the last dose of caffeine and may last for up to one week.

What are the signs of Caffeine Addiction?

To determine if someone is addicted to caffeine is not based on the quantity of caffeine consumed but how this affects an individual’s day-to-day functioning.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) does not recognize Caffeine addiction as a substance use disorder, but it does recognize it as a condition for future study. According to the DSM-5, problematic Caffeine consumption is characterized by at least three of the following criteria:

• 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 characterized by the above symptoms mentioned
• Caffeine is often taken in larger amounts or over a longer period than was intended
• Recurrent Caffeine use resulting in a failure to fulfil major role obligations at work, school, or home
• Continued Caffeine use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of Caffeine
• Tolerance as defined above
• 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

How do you help someone with a Caffeine addiction?

People that regularly consume Caffeine need to make good and responsible choices when it comes to consumption, such as limiting intake to only one or two cups of coffee a day.

One may also be able to help another by:

• Talking to them about your observation without any judgement or blame
• Be empathetic and supportive
• Link them with available resources if you know any
• Encourage them to seek help or continue to seek help

Cannabis Use/Addiction

What is Cannabis?

Cannabis is a generic term used to denote the several psychoactive preparations of the plant Cannabis sativa. The major psychoactive constituent in cannabis is Delta-9 tetrahydrocannabinol (THC).

The Mexican term 'marijuana' is frequently used in referring to cannabis leaves or other crude plant material in many countries. The unpollinated female plants are called hashish. Cannabis oil (hashish oil) is a concentrate of cannabinoids obtained by solvent extraction of the crude plant material or of the resin. Cannabis is typically smoked, either in a cigarette form or via a pipe, while the drug may also be misused by brewing it in tea or cooking it in certain foods.

What are the effects of Cannabis?

Cannabis can affect the body in many different ways. Many of these effects are short term, that is they only last for a short time and others are long term and most likely occur later.

Short term effects include:

• Relaxation
• Sense of Happiness
• Reduction in body temperature
• Red eyes
• Nausea and vomiting
• Dry mouth & throat
• Hunger (commonly known as Munchies)
• Panic and/or Anxiety
• Confusion
• Paranoia
• Altered perception such as:
• Distortion of time
• Intensified sense of touch, smell and taste

Long term effects include:

Effects on the brain are:

• Impaired memory
• Impaired concentration
• Impaired intelligence
• Impairment in the ability to think and make decisions
• Increased risk of developing mental health conditions

Effects on physical health are:

• Lung infections
• Chronic cough
• Bronchitis

What is Cannabis Addiction?

Defining cannabis addiction is similar to that of Caffeine addiction. Additionally, the terms Tolerance, Dependence and Withdrawal are same as discussed earlier in this glossary for Caffeine addiction.

However, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) considered Cannabis addiction a substance use disorder unlike Caffeine addiction. Also, the same criteria apply here. (Kindly refer to the glossary on Caffeine addiction for the diagnostic criteria of Addiction).

How to help someone with Cannabis Addiction?

There are a number of treatment options available. However, the mainstay treatment for Cannabis addiction is DRUG REHABILITATION. Drug rehabilitation can be done on both In-patient and out-patient basis depending on the severity of addiction and degree of impairment on function.

A major first step is to acknowledge that one has a cannabis use problem so they can make a bold step to seek help. Secondly, it is highly advisable to see a psychiatrist for a full and thorough assessment. Following this, a comprehensive treatment plan will be developed with the person so they can get all the help they need. In the case of an underlying mental health condition, appropriate treatment (medications and therapy) would be given. Also, other supportive treatment options include:

• Therapy with a clinical psychologist
• Occupational therapy
• Social welfare if required

In case you or anyone you know is struggling with cannabis use, consider booking a session with our mental health professionals for further assessment and management.

Claustrophobia

What is Claustrophobia?

Claustrophobia is a form of anxiety disorder, and a type of specific phobia in which there is irrational fear of having no escape or being closed-in and can lead to a panic attack.

What are the signs/symptoms of Claustrophobia?

This will vary for everyone and range from mild to severe forms. In moderate to severe claustrophobia, there is usually a significant impact on a person’s daily function and most likely would require medical intervention.

Some of the symptoms include:

• Shortness of breath
• Hyperventilation (fast and shallow breathing)
• Palpitations
• Sweating, often profusely
• Shaking/ trembling
• Nausea/ vomiting
• Hot flashes
• Chest tightening/pain
• Confusion
• Headache
• Numbness
• Fear of harm
• Felling a sense of doom like one is going to die

What can cause Claustrophobia?

There is no known cause but there are certain factors that predisposes one to developing this phobia. A few are as follows:

• A traumatic childhood experience such as bullying, abuse or being stuck in an enclosed space
• A family history of anxiety disorders
• Having an underlying anxiety disorder

Examples of triggers of Claustrophobia are?

• Elevators
• Airplanes/trains
• Car washes
• Tunnels
• Changing rooms or bathroom stalls

Claustrophobia is mostly diagnosed by a medical practitioner particularly a psychiatrist. This is usually done through assessments.

How do we treat Claustrophobia?

The mainstay treatment is therapy with a clinical psychologist. In addition, they equip people with healthy coping mechanisms to overcome such situations.

Medications are not routinely prescribed for Claustrophobia but are given when it affects one’s life immensely or there is another underlying mental health condition such as anxiety disorder, depression etc.

Conduct Disorder

What is conduct disorder?

"Conduct disorder" refers to a group of repetitive and persistent behavioural and emotional problems in children and adolescents. Young people with this disorder often have great difficulty obeying rules, respecting the rights of others, exhibiting empathy and following acceptable social norms.

They are often labelled as “difficult”, “bad” or “very naughty”.

What can cause Conduct disorder?

Like many other mental health challenges/conditions, there is no known cause. There is usually an interplay of a number of factors that contribute to a child developing this condition.

• Brain damage as a result of a traumatic delivery, head injury of an illness that affects the brain.
• A traumatic event such as abuse, car accident, kidnapping, bullying
• Family history of conduct disorder
• Social problems e.g., Parental discord, lack of parental control, dysfunctional homes, poor academic performance etc.

Conduct disorder is more common in boys than girls and is more likely to occur in children/teens who besides the above risk factors also have underlying conditions such as:

• Mood/anxiety disorder
• Post-traumatic stress disorder
• Substance use disorder
• Attention deficit hyperactive disorder
• Learning problems

What are the symptoms/signs of conduct disorder?

The symptoms and signs are grouped under 4 categories of behaviour:

• Aggressive Conduct 
• Intimidating behaviour e.g., Bullying, threatening or intimidating others
• Enjoys being cruel or mean to others
• Engages in physical fights or uses weapons to harm people
• Cruelty to animals
• Stealing or pilfering
• Lack of remorse
• Destruction of property: 
• Deliberate fire setting with intention to damage property
• Deliberately destroying other’s properties
• Deceitfulness 
• Lying to obtain goods/favours/avoid obligations
• Stealing e.g., Shoplifting
• Violations of rules/age-appropriate norms 
• Truancy
• Running away from home
• Mischief/pranks
• Engages in very early sexual activity

How is conduct disorder diagnosed?

A child & adolescent psychiatrist or a qualified mental health expert can diagnose conduct disorder following a thorough assessment of the child/teen. Besides parents, teachers are very good informants.

What is the treatment for conduct disorder?

Treatment for conduct disorder can be difficult, challenging and complex. The mainstay treatment is Behavioural therapy. Other forms of treatment are:

• Family therapy
• Anger management
• Parental skills training
• Special education for those with learning difficulties

Medication is usually prescribed in cases of underlying or presence of other conditions e.g. Childhood depression, post-traumatic stress disorder etc.

There is evidence that children with this disorder are likely to have ongoing problems if they and their families do not receive early and comprehensive interventions. Without treatment, many are unable to adapt or cope with the demands of adulthood and continue to have significant problems in the future e.g., Holding down a job and/or relationships, legal problems or criminal behavior.