Stress and Burnout Among Graduate Students: Moderation by Sleep Duration and Quality.

BACKGROUND: There are high levels of stress among graduate students, and stress is associated with multiple negative outcomes among student populations, including academic burnout. Sleep could play an important role in explaining the association between stress and burnout, but these relationships have not been explored among the graduate student population. The current study assessed whether or not sleep duration and quality moderated the relationship between stress and burnout (i.e., exhaustion, cynicism, and inefficacy) among graduate students. METHODS: A sample of 2683 master's, doctoral, and professional graduate students from two large, public universities completed an online survey. Linear regression models with interaction terms were developed to evaluate the relationships between stress and burnout while examining moderation by sleep duration and quality. RESULTS: Participants slept an average of 6.4 h per night, with 62% indicating good sleep quality. Stress had significant, positive relationships with exhaustion, cynicism, and inefficacy. The relationship between stress and exhaustion lessened as sleep duration increased, and the relationship between stress and exhaustion was weaker among students with good sleep quality when compared with those with poor sleep quality. Neither sleep duration nor sleep quality moderated the relationships between stress and cynicism or stress and inefficacy. CONCLUSIONS: Improving sleep habits has the potential to lessen the negative association between stress and graduate student functioning. Future research utilizing longitudinal designs is needed to understand the temporality of these associations and the influence of possible co-factors like individual propensity for mental health problems and social support.

Nonmedical Use of Prescription Stimulants as a "Red Flag" for Other Substance Use.

BACKGROUND: Nonmedical use of prescription stimulants (NMPS) has increased on college campuses during the past two decades. NMPS is primarily driven by academic enhancement motives, and normative misperceptions exist as well. However, large, nationwide studies have not yet been conducted to generalize findings more broadly and gain a deeper understanding of the relationship between NMPS and other substance use (e.g. alcohol use, marijuana, etc.). The present study was conducted to lay the foundation for prevention efforts related to NMPS by establishing NMPS prevalence, practices surrounding NMPS, and other substance use. METHODS: N = 2,989 students from seven universities around the U.S. completed a web-based survey assessing NMPS practices and related behaviors. Prevalence and factors associated with NMPS were explored. RESULTS: Analyses revealed a 17% past-year prevalence of NMPS with associated widespread misperceptions of peer use. NMPS was significantly related to alcohol use, binge drinking, and marijuana use, as well as skipped classes and affiliation with Greek life. CONCLUSIONS: Although most college students do not report NMPS, those who do also are more likely to report alcohol use, binge drinking, and marijuana use, and NMPS could be a "red flag" for other risk behaviors worth exploring. Implications for prevention and intervention are discussed.

Prevalence and incidence of drug use among college students: an 8-year longitudinal analysis.

BACKGROUND: Drug use among college students is associated with adverse academic and health outcomes and risks to personal safety. OBJECTIVES: This study utilized data from a longitudinal study to estimate annual prevalence, cumulative lifetime prevalence, and incidence of ten types of drug use during the eight years after college entry and the average age of onset of each drug used. METHODS: Participants (N = 1,253; 52% female) were young adults who were originally enrolled as first-time, first-year students at a university in the mid-Atlantic US. Annual personal interviews gathered data about the use of seven illicit drugs and three prescription drugs used nonmedically. Annual follow-up rates ranged from 76 to 91%. RESULTS: Marijuana was the most commonly used drug in every year of the study, with the highest annual prevalence estimates in Year 3 (47%wt). In Year 8, when the modal age of participants was 25, 29%wt used marijuana during the past year. Nonmedical use of prescription drugs was more prevalent during college than in the later years of the study. Although the prevalence of cocaine and ecstasy use was low (cumulative prevalence estimates of 17%wt and 13%wt, respectively), incidence for these drugs was particularly high in the later years of the study. CONCLUSION: Drug use is prevalent among college students, and drug use persists among young adults, even after many have graduated college. More attention should be directed at identifying and intervening with students at risk for drug use to mitigate possible academic, health, and safety consequences.

Energy Drink Use Patterns Among Young Adults: Associations with Drunk Driving.

BACKGROUND: Highly caffeinated "energy drinks" (ED) are commonly consumed and sometimes mixed with alcohol. Associations between ED consumption, risk-taking, and alcohol-related problems have been observed. This study examines the relationship between ED consumption-both with and without alcohol-and drunk driving. METHODS: Data were derived from a longitudinal study of college students assessed annually via personal interviews. In Year 6 (modal age 23; n = 1,000), participants self-reported their past-year frequency of drunk driving, ED consumption patterns (frequency of drinking alcohol mixed with energy drinks [AmED] and drinking energy drinks without alcohol [ED]), alcohol use (frequency, quantity), and other caffeine consumption. Earlier assessments captured suspected risk factors for drunk driving. Structural equation modeling was used to develop an explanatory model for the association between ED consumption patterns and drunk driving frequency while accounting for other suspected risk factors. RESULTS: More than half (57%) consumed ED at least once during the past year. Among ED consumers, 71% drank AmED and 85% drank ED alone; many (56%) engaged in both styles of ED consumption while others specialized in one or the other (29% drank ED alone exclusively, while, 15% drank AmED exclusively). After accounting for other risk factors, ED consumption was associated with drunk driving frequency in 2 ways. First, a direct path existed from ED frequency (without alcohol) to drunk driving frequency. Second, an indirect path existed from AmED frequency through alcohol quantity to drunk driving frequency. CONCLUSIONS: Among this sample, ED consumption with and without alcohol was common, and both styles of ED consumption contributed independently to drunk driving frequency. Results call for increased attention to the impact of different patterns of ED consumption on alcohol-related consequences, such as drunk driving.

Drinking Like an Adult? Trajectories of Alcohol Use Patterns Before and After College Graduation.

BACKGROUND: College students who engage in high-risk drinking patterns are thought to "mature out" of these patterns as they transition to adult roles. College graduation is an important milestone demarcating this transition. We examine longitudinal changes in quantity and frequency of alcohol consumption between the college years and the 4 years after graduation and explore variation in these changes by gender and race/ethnicity. METHODS: Participants were 1,128 college graduates enrolled in a longitudinal prospective study of health-risk behaviors. Standard measures of alcohol consumption were gathered during 8 annual personal interviews (76 to 91% annual follow-up). Graduation dates were culled from administrative data and self-report. Spline models, in which separate trajectories were modeled before and after the "knot" of college graduation, were fit to 8 annual observations of past-year alcohol use frequency and quantity (typical number of drinks/drinking day). RESULTS: Frequency increased linearly pregraduation, slightly decreased postgraduation, and then rebounded to pregraduation levels. Pregraduation frequency increased more steeply among individuals who drank more heavily at college entry. Quantity decreased linearly during college, followed by quadratic decreases after graduation. CONCLUSIONS: Results suggest that the postcollege "maturing-out" phenomenon might be attributable to decreases in alcohol quantity but not frequency. High-frequency drinking patterns that develop during college appear to persist several years postgraduation.

False identification use among college students increases the risk for alcohol use disorder: results of a longitudinal study.

BACKGROUND: It is well known that using false identification (ID) is a common method by which underage youth in the United States obtain alcohol. While false ID use is associated with high-risk drinking patterns, its association with alcohol use disorder (AUD), independent of other risk factors, has not been firmly established. METHODS: Participants were 1,015 college students recruited from 1 university and assessed annually during their first 4 years of college. Latent variable growth curve modeling was used to identify significant predictors of false ID use and test the hypothesis that false ID use increased the risk for AUD, by increasing the frequency and/or quantity of alcohol use. Several other hypothesized risk factors for AUD were accounted for, including demographics (sex, race, living situation, religiosity, socioeconomic status), individual characteristics (childhood conduct problems, sensation-seeking, age at first drink), high school behaviors (high school drinking frequency, drug use), family factors (parental monitoring, parental alcohol problems), perception of peer drinking norms, and other factors related to false ID use. RESULTS: False IDs were used by almost two-thirds (66.1%) of the sample. False ID use frequency was positively associated with baseline quantity and frequency of alcohol use, independent of all other factors tested. False ID use was not directly related to AUD risk, but indirectly predicted increases in AUD risk over time through its association with greater increases in alcohol use frequency over time. Several predictors of false ID use frequency were also identified. CONCLUSIONS: False ID use may contribute to AUD risk by facilitating more frequent drinking. If replicated, these findings highlight the potential public health significance of policies that enforce sanctions against false ID use. Students who use false IDs represent an important target population for alcohol prevention activities.

Providing alcohol to underage youth: the view from young adulthood.

BACKGROUND: Many underage drinkers obtain alcohol from legal-age family, friends, and acquaintances. This study aimed to understand the attitudes and behaviors of young adults related to providing alcohol to underage drinkers. METHODS: Participants were 755 current or recent college students of legal drinking age (ages 22 to 26) who were approached by a minor to provide alcohol at least once since turning 21. Interviewers assessed frequency of providing alcohol, relationship to the recipients, and general attitudes about providing alcohol to minors. Separate questions asked about younger (under 18) and older (18 to 20) minors. Correlates and predictors of provision and frequency of provision were examined via logistic regression and Poisson regression, focusing on demographics, sensation-seeking, behavioral dysregulation, age at first drink, parental history of alcohol problems, fraternity/sorority involvement, attitudes about provision, violations, peer drinking norms, and alcohol use disorder (AUD) risk during and post-college. RESULTS: Most participants (84.6%) provided alcohol to minors at least once. Provision to older minors was more prevalent (82.8%) than to younger minors (20.7%); it was also more frequent. Few (2.4%) were ever caught providing alcohol. Recipients were more commonly friends or family members rather than acquaintances or strangers. Legal concerns about providing alcohol (82.5 and 53.7% for younger and older minors, respectively) were more prevalent than health concerns (55.7 and 9.5%). Legal concerns consistently predicted lower likelihood of provision, independent of demographics. Health concerns and lower post-college AUD risk scores also independently predicted lower likelihood of provision, but only to older minors. Fraternity/sorority involvement and higher peer drinking norms were associated with higher provision frequency, whereas legal concerns and college violations were associated with lower provision frequency. CONCLUSIONS: Young adults who have recently turned 21 could represent an important target for prevention strategies to reduce underage drinking on college campuses. More research is needed to understand the motivations of young adults who provide alcohol to underage drinkers.

Implementation of a computerized tool to address barriers to academic success among college students.

OBJECTIVE: Academic assistance professionals work with college students to address barriers to academic success, although few assessment tools exist. This feasibility study examined the results of implementing a computerized tool for academic assistance professionals to help students. The Measure of Obstacles to Succeeding Academically in College (MOSAIC) is a 31-item risk assessment tool used to characterize academic barriers. It utilizes a tailored computer algorithm on a mobile device to match students with resources to address academic barriers. METHODS: The MOSAIC was customized and administered at seven universities around the United States. Student responses were analyzed in Microsoft Excel. Academic assistance professionals were asked about implementation in unstructured interviews. RESULTS: Stress and study skill concerns were the most reported barriers. The MOSAIC was well received, especially among students experiencing academic difficulties, but integration into routine workflow was an obstacle to sustained implementation. CONCLUSIONS: The MOSAIC holds promise in addressing issues impeding academic success.

Social contexts of drinking and subsequent alcohol use disorder among college students.

BACKGROUND: Previous research has suggested important contextual factors that can differentiate problem and nonproblem drinkers. OBJECTIVES: To evaluate the strength of the prospective association between social contexts of drinking and subsequent alcohol use disorder and drunk driving 2-3 years later. METHODS: The sample consisted of 652 individuals who were originally recruited at college entry, had complete data on at least one social context subscale, met the minimum criteria for Year 1 drinking, and had nonmissing data on at least one of the outcome variables in Years 3 and/or 4. Social contexts of drinking were assessed in Year 1 by using previously validated scales measuring six different situational and motivational contexts in which alcohol is consumed. DSM-IV criteria for alcohol abuse and dependence and drunk driving were assessed annually. RESULTS: Holding constant gender, race/ethnicity, and baseline drinking frequency, the frequency of drinking in a context of social facilitation, sex-seeking, or in a motor vehicle during Year 1 was significantly related to a greater likelihood of alcohol abuse, alcohol dependence, and drunk driving in Years 3 and/or 4. Drinking in a context of emotional pain was related to alcohol dependence and drunk driving but not to alcohol abuse. CONCLUSIONS: The Social Context of Drinking Scales have utility for identifying students who are at risk for developing alcohol-related problems. SCIENTIFIC SIGNIFICANCE: Identifying college students who might develop alcohol dependence requires an assessment of both situational and motivational factors that influence drinking, especially drinking in a motor vehicle.

Cigarette smoking among college students: longitudinal trajectories and health outcomes.

INTRODUCTION: Light and intermittent patterns of cigarette smoking are prevalent among U.S. college-aged individuals. It is unclear whether intermittent smokers maintain their use over time or are transitioning to daily use or nonuse, and whether they experience more adverse health outcomes than nonsmokers. METHODS: This study examined the trajectories of tobacco cigarette smoking, their predictors, and health outcomes among students (N = 1,253) assessed during their first year of college (Y(1)) and annually thereafter (Y(2), Y(3), and Y(4)). RESULTS: In Y(1), 3.4% smoked daily and 4.1% exhibited signs of dependence (first cigarette within 30 min of waking). Growth curve modeling identified five distinct smoking trajectories. After stable nonsmokers (71.5%(wt)), the low-stable smoking trajectory was the most common (13.3%(wt)), outnumbering both low-increasing (6.5%(wt)) and high-stable smokers (5.5%(wt)) by 2:1 and high-decreasing smokers (3.2%(wt)) by 4:1. The likelihood of maintaining a low level of smoking over time was inversely related to Y(1) smoking frequency. Few demographic, smoking, and alcohol use characteristics measured in Y(1) distinguished low-increasers from low-stable smokers or high-decreasers from high-stable smokers. By Y(4), high-stable smokers rated their health significantly worse than all others except low-increasers. High-stable smokers had the most Y(4) health problems (i.e., provider visits for health problems and days of illness-related impairment), but only among nonWhites. CONCLUSIONS: Many college students smoke, but few smoke daily or are nicotine dependent. Intermittent smoking patterns are often stable throughout college and are associated with adverse health outcomes. Prevention strategies should be designed to mitigate the possible long-term health consequences of light and intermittent smoking.

Marijuana exposure opportunity and initiation during college: parent and peer influences.

Marijuana is the most prevalent illicit drug used by adolescents and young adults, yet marijuana initiation is rarely studied past adolescence. The present study sought to advance our understanding of parent and peer influences on marijuana exposure opportunity and incident use during college. A sample of 1,253 students was assessed annually for 4 years starting with the summer prior to college entry. More than one-third (38%(wt)) of students had already used marijuana at least once prior to college entry; another 25%(wt) initiated use after starting college. Of the 360 students who did not use marijuana prior to college, 74% were offered marijuana during college; of these individuals, 54% initiated marijuana use. Both low levels of parental monitoring during the last year of high school and a high percentage of marijuana-using peers independently predicted marijuana exposure opportunity during college, holding constant demographics and other factors (AOR = 0.92, 95% CI = 0.88-0.96, p < .001 and AOR = 1.11, 95% CI = 1.08-1.14, p < .001, respectively). Among individuals with exposure opportunity, peer marijuana use (AOR = 1.04, 95% CI = 1.03-1.05, p < .001), but not parental monitoring, was associated with marijuana initiation. Results underscore that peer influences operate well into late adolescence and young adulthood and thus suggest the need for innovative peer-focused prevention strategies. Parental monitoring during high school appears to influence exposure opportunity in college; thus, parents should be encouraged to sustain rule-setting and communication about adolescent activities and friend selection throughout high school.

Graduate student burnout: Substance use, mental health, and the moderating role of advisor satisfaction.

Substance use and mental health problems are associated with academic difficulties among high school and undergraduate students, but little research has been conducted on these relationships among graduate students. The sample consisted of 2,683 graduate students attending two large, public universities. Standard measures were used to collect data on demographic and program characteristics, mental health, substance use, advisor satisfaction, and burnout (i.e., exhaustion, cynicism, and inefficacy). Linear regression models evaluated relationships between each mental health and substance use variable with burnout, as well as the moderating role of advisor satisfaction. Students with a greater number of substance use and mental health problems had higher levels of exhaustion, cynicism, and inefficacy. No statistically significant relationships between substance use and burnout were found. High levels of stress, moderate or severe anxiety symptoms, and moderate or severe depressive symptoms were associated with increased levels of burnout. Advisor support moderated the relationships between stress and both cynicism and inefficacy such that the effects of stress on these dimensions of burnout were lower among those who were satisfied with their advisor. Graduate students with mental health problems might be at increased risk for burnout; however, having a supportive advisor might buffer this association.

In harm's way: Do college students' beliefs about cannabis put them at risk for use?

Objective: This study describes beliefs held by college students about cannabis use and examines the association between three specific cannabis beliefs and likelihood of use. Participants: 3,720 undergraduate students ages 18 to 25 attending ten colleges in one state. Methods: Data were gathered via online survey. Results: The majority (80%) of the sample was unsure or believed that cannabis was an effective way to reduce stress; 67% were unsure or believed that cannabis was not related to an increased risk for mental health problems; and 62% were unsure or believed that students who use cannabis are not more academically disengaged. Holding these beliefs, which are not supported by scientific evidence, was associated with a greater likelihood of cannabis use, even after statistically adjusting for covariates. Conclusions: These findings suggest that beliefs unsupported by scientific evidence are widespread among college students. Dispelling misinformation about cannabis might hold promise for reducing use.

Substance use and mental health problems among graduate students: Individual and program-level correlates.

OBJECTIVE: This study evaluated variation in substance use and mental health among graduate student subgroups. PARTICIPANTS: A sample of 2,683 master's and doctoral students completed an online survey in October 2017. METHODS: Subgroup variation in behavioral health by demographic and program characteristics, particularly degree type and academic discipline, was explored. RESULTS: Compared with academic doctoral students (ie, PhD students), professional doctoral students (ie, MD, JD, etc.) were significantly more likely to report high stress levels and moderate or severe anxiety symptoms. Master's students were more likely to report moderate or severe anxiety symptoms and use marijuana than academic doctoral students. Students in the behavioral and social sciences, social work, and arts and humanities disciplines were more likely to use substances and report mental health problems than engineering and business students. CONCLUSIONS: These findings highlight graduate student subgroups who might require closer attention with respect to access to behavioral health services.

Energy drink consumption and increased risk for alcohol dependence.

BACKGROUND: Energy drinks are highly caffeinated beverages that are increasingly consumed by young adults. Prior research has established associations between energy drink use and heavier drinking and alcohol-related problems among college students. This study investigated the extent to which energy drink use might pose additional risk for alcohol dependence over and above that from known risk factors. METHODS: Data were collected via personal interview from 1,097 fourth-year college students sampled from 1 large public university as part of an ongoing longitudinal study. Alcohol dependence was assessed according to DSM-IV criteria. RESULTS: After adjustment for the sampling design, 51.3%(wt) of students were classified as "low-frequency" energy drink users (1 to 51 days in the past year) and 10.1%(wt) as "high-frequency" users (≥52 days). Typical caffeine consumption varied widely depending on the brand consumed. Compared to the low-frequency group, high-frequency users drank alcohol more frequently (141.6 vs. 103.1 days) and in higher quantities (6.15 vs. 4.64 drinks/typical drinking day). High-frequency users were at significantly greater risk for alcohol dependence relative to both nonusers (AOR = 2.40, 95% CI = 1.27 to 4.56, p = 0.007) and low-frequency users (AOR = 1.86, 95% CI = 1.10, 3.14, p = 0.020), even after holding constant demographics, typical alcohol consumption, fraternity/sorority involvement, depressive symptoms, parental history of alcohol/drug problems, and childhood conduct problems. Low-frequency energy drink users did not differ from nonusers on their risk for alcohol dependence. CONCLUSIONS: Weekly or daily energy drink consumption is strongly associated with alcohol dependence. Further research is warranted to understand the possible mechanisms underlying this association. College students who frequently consume energy drinks represent an important target population for alcohol prevention.

Prescription analgesic use among young adults: adherence to physician instructions and diversion.

OBJECTIVES: To understand the extent to which medication adherence was related to diversion of prescription analgesics. DESIGN: Cross-sectional analyses of data from the College Life Study, a prospective study of young adults. SETTING: Participants were originally sampled as incoming first-time first-year college students from one large public university in the Mid-Atlantic United States. PARTICIPANTS: One hundred ninety-two young adults aged 21-26 who were prescribed an analgesic to treat acute pain in the past year. OUTCOME MEASURE: Diversion of prescription analgesics. The study tested two competing hypotheses: 1) individuals who skip doses (under-users) are at greatest risk for diversion because they have leftover medication; and 2) individuals who over-use their prescriptions (over-users) are at greatest risk for diversion, perhaps because of a general propensity to engage in deviant behavior. RESULTS: Fifty-eight percent followed physician's instructions regarding their prescription analgesic medication; 27% under-used their prescribed medication and 16% over-used their prescribed medication. Twenty-seven percent of the total sample diverted their medication, with over-users being the most likely to divert (63%). Holding constant demographic characteristics and perceived harmfulness of nonmedical use, over-users were almost five times as likely as adherent users to divert analgesic medications (P < 0.05). CONCLUSIONS: Further research is needed to better understand the relationship between adherence and diversion. If these findings are replicated, physicians who are involved in pain management for acute conditions among young adults should take steps to monitor adherence and reduce diversion of prescription analgesics.

The association between early conduct problems and early marijuana use in college students.

Early conduct problems have been linked to early marijuana use in adolescence. The present study examines this association in a sample of 1,076 college students that was divided into three groups: 1) early marijuana users (began marijuana use prior to age 15; n=126), 2) late marijuana users (began marijuana use at or after age 15; n=607), and 3) non-users (never used marijuana; n=343). A conduct problem inventory used in previous studies was adapted for use in the present study. Early conduct problems were associated with early marijuana use but not with late marijuana use, holding constant other risk factors. Results suggest that early conduct problems are a risk factor for early marijuana use even among academically-achieving college-bound students.

Trends in alcohol-related traffic risk behaviors among college students.

BACKGROUND: Alcohol-impaired driving is a major public health problem. National studies indicate that about 25% of college students have driven while intoxicated in the past month and an even greater percentage drive after drinking any alcohol and/or ride with an intoxicated driver. The purpose of this investigation was to examine the change in these various alcohol-related traffic risk behaviors as students progressed through their college experience. METHODS: A cohort of 1,253 first-time first-year students attending a large, mid-Atlantic university were interviewed annually for 4 years. Repeated measures analyses were performed using generalized estimating equations to evaluate age-related changes in prevalence and frequency of each behavior (i.e., ages 19 to 22). RESULTS: At age 19, 17%(wt) of students drove while intoxicated, 42%(wt) drove after drinking any alcohol, and 38%(wt) rode with an intoxicated driver. For all 3 driving behaviors, prevalence and frequency increased significantly at age 21. Males were more likely to engage in these behaviors than females. To understand the possible relationship of these behaviors to changes in drinking patterns, a post hoc analysis was conducted and revealed that while drinking frequency increased every year, frequency of drunkenness was stable for females, but increased for males. CONCLUSIONS: Alcohol-related traffic risk behaviors are quite common among college students and take a significant upturn when students reach the age of 21. Prevention strategies targeted to the college population are needed to prevent serious consequences of these alcohol-related traffic risk behaviors.

The impact of positive and negative ecstasy-related information on ecstasy use among college students: Results of a longitudinal study.

AIMS: To: 1) estimate the proportion of students exposed to specific types of information regarding the positive and negative effects of ecstasy, 2) test models that quantified the relationship between exposure to these messages and subsequent ecstasy use, controlling for peer drug use and sensation-seeking. METHODS: As part of the College Life Study, 447 students, ages 17-20, from a university in the mid-Atlantic region of the US completed an in person interview plus three follow-up assessments. FINDINGS: Individuals who had heard a greater number of negative messages were significantly more likely to use ecstasy, even controlling for positive messages, prior ecstasy use, peer ecstasy use, perceived harm, sensation-seeking, sex, and race. Some messages were significant at the bivariate level. CONCLUSIONS: Ecstasy use may have been influenced more by the content of the messages than by the quantity or diversity of messages. Interventions should be designed to address both positive and negative perceptions about a particular drug, rather than focusing exclusively on the negative information. Future evaluations should focus on the effectiveness of multi-pronged sustainable prevention programs in reducing adolescent drug use risk.

Prevalence and Correlates of Caffeine Use Disorder Symptoms Among a United States Sample.

Background: The DSM-5 recognizes caffeine use disorder as a condition for further study, but there is a need to better understand its prevalence and clinical significance among the general population. Methods: A survey was conducted among an online sample of 1006 caffeine-consuming adults using demographic quotas to reflect the U.S. population. Caffeine consumption, DSM-proposed criteria for caffeine use disorder, sleep, substance use, and psychological distress were assessed. Results: Eight percent of the sample fulfilled DSM-proposed criteria for caffeine use disorder. These individuals consumed more caffeine, were younger, and were more likely to be cigarette smokers. Fulfilling caffeine use disorder criteria was associated with caffeine-related functional impairment, poorer sleep, some substance use, as well as greater depression, anxiety, and stress. Conclusions: The prevalence of caffeine use disorder among the present sample suggests that the proposed diagnostic criteria would identify only a modest percentage of the general population, and that identified individuals experience significant caffeine-related distress.