Investigating the role of expectancy in caffeine withdrawal using the balanced placebo design.

OBJECTIVE: This study investigated psychological influences on drug withdrawal symptomatology using a caffeine-based model. METHODS: Using the 2 × 2 balanced placebo design caffeine dose (given caffeinated vs decaffeinated coffee) was crossed with dose expectancy (told caffeine vs. decaf) among 87 (16-hr abstinent) regular coffee consumers in a 2-day study. RESULTS: There were effects of expectancy and pharmacology that differed depending on the measure. Those told decaf reported greater caffeine cravings than those told caffeine 45 min and 8 hr postmanipulation. There were no expectancy effects on withdrawal symptoms or cognitive performance. There were pharmacological effects on all measures. Those given decaf reported greater withdrawal symptoms and showed poorer cognitive performance 45 min and 8 hr postmanipulation, with effects for headache and flu-like symptoms first emerging 8 hr postmanipulation (i.e., 24 hr abstinence in given decaf conditions). Caffeine readministration alleviated all withdrawal symptoms and cognitive decrements within 45 min. No drug by expectancy interactions were observed. CONCLUSIONS: These findings confirm a strong pharmacological basis for caffeine withdrawal and an important role of cognition in drug craving. Future research should investigate the role of expectancy in drug withdrawal and craving and the potential use of expectancy manipulations in symptom prevention and management.

Pain Symptoms Associated with Opioid Use among Vulnerable Persons with HIV: An exploratory study with implications for palliative care and opioid abuse prevention.

Current or former injection drug users with human immunodeficiency virus (HIV) are at high risk for pain, which adversely affects their quality of life and may increase their risk for illicit drug use or relapse. We explored associations between pain symptoms and substance use among injection-drug-using study participants with HIV who had histories of heroin use. Using generalized estimating equations and controlling for prior substance use, we found that pain in each six-month period was associated with the use of heroin and prescription opioids, but not the use of nonopioid drugs or alcohol. Routine clinical assessment and improved management of pain symptoms may be needed for persons with HIV and a history of injection drug use, particularly those with chronic pain, for whom there is increased risk for heroin use.

Development of the caffeine withdrawal symptom questionnaire: caffeine withdrawal symptoms cluster into 7 factors.

BACKGROUND: Habitual caffeine consumers who abstain from caffeine experience withdrawal symptoms such as headache, fatigue, difficulty concentrating, mood disturbances, and flu-like symptoms (Juliano and Griffiths, 2004). The caffeine withdrawal syndrome has been documented across many experimental studies; however, little is known about how withdrawal symptoms co-vary during a discrete episode. Furthermore, a validated measure of caffeine withdrawal is lacking. OBJECTIVE: To develop, evaluate, and reduce a 23-item measure of caffeine withdrawal symptoms; the Caffeine Withdrawal Symptom Questionnaire (CWSQ), to a set of composite variables. METHODS: Caffeine consumers (N=213) completed the CWSQ after 16h of caffeine abstinence. A subset of participants also completed the CWSQ during a preceding baseline period and/or after double-blind consumption of caffeinated coffee. RESULTS: Principal components analysis resulted in a solution comprised of 7-factors: (1) Fatigue/drowsiness; (2) Low alertness/difficulty concentrating; (3) Mood disturbances; (4) Low sociability/motivation to work; (5) Nausea/upset stomach; (6) Flu-like feelings; and (7) Headache. With the exception of nausea/upset stomach, the CWSQ total score and individual composite scores were significantly greater during caffeine abstinence relative to both baseline and double-blind consumption of caffeinated coffee, thereby demonstrating sensitivity of the measure. Compared to non-daily coffee consumers, daily consumers had greater increases in total withdrawal, fatigue/drowsiness, low alertness/difficulty concentrating, mood disturbances, and headache. CONCLUSIONS: Future directions include replication, assessment on a clinical population, and further examination of psychometric properties of the CWSQ. The CWSQ should facilitate the assessment and diagnosis of caffeine withdrawal and increase our knowledge of the caffeine withdrawal syndrome.

Caffeine expectancies influence the subjective and behavioral effects of caffeine.

OBJECTIVES: This study investigated the independent and interactive effects of caffeine pharmacology and expected effects of caffeine on performance and subjective outcomes. METHODS: Abstinent coffee drinkers (n = 60) consumed decaffeinated coffee with either 280 mg or 0 mg added caffeine. Caffeine dose was crossed with varying instructions that the coffee would either enhance or impair performance in a 2 x 2 factorial design. Performance, mood, caffeine withdrawal, and negative somatic effects were assessed. RESULTS: Relative to placebo, caffeine improved reaction time and accuracy on the rapid visual information processing task, a measure of vigilance. However, there was a significant dose by expectancy interaction that revealed that among participants given placebo coffee, "impair" instructions produced better performance than "enhance" instructions. Caffeine also improved psychomotor performance as indicated by a finger tapping task with no main effects of expectancy or interactions. Impair instructions produced greater reports of negative somatic effects than enhance instructions, but only when caffeine was administered. CONCLUSIONS: Manipulating the expected effects of caffeine altered the behavioral and subjective effects of caffeine. A significant dose by expectancy interaction revealed a somewhat paradoxical outcome in the placebo conditions whereby those told "impair" performed better than those told "enhance." This may reflect compensatory responding as has been observed in similar studies using alcohol (Fillmore et al. Psychopharmacology 115:383-388, 1994). Impair instructions led to greater negative somatic effects only when caffeine was administered supporting the active placebo hypothesis.