Most of us think of caffeine as a harmless way to inject vitality when we need that extra surge. Give us this day our daily jolt becomes our mantra. Of course, we can get caffeine from many sources besides coffee and tea. Caffeine is an ingredient in many foods and over-the-counter medications ranging from chocolate to sleep aids to headache remedies. It's a perfectly legal drug, even in the product called "AeroShot," the newest entry into the energy marget. AeroShot is an inhalant used to deliver caffeine directly into your system. Available for sale in Massachusetts, New York, and France, this latest entry into the energy scene is unregulated by the U.S. Food and Drug Administration because it's an additive, not a "drug."

To say that caffeine is not a drug is like saying that storks deliver babies. It's not only unscientific, but completely misleading. The most widely-used psychoactive drug in the world, caffeine activates neuromodulators in the brain that increase an individual's perceived level of energy and alertness. Unfortunately, caffeine also increases the body's production of cortisol, the stress hormone. Adverse reactions to caffeine occur rarely, but can include risk of death due to spikes in blood pressure and heart rate.

Energy drinks such as Red Bull, introduced in Austria in 1987 and in the U.S. in 1997, are becoming an increasing problem due to the high levels of caffeine they contain. Red Bull contains 80 mg of caffeine, but Wired X505 contains a whopping 505 mg per can. In comparison, a can of Coca Cola contains 34.5 mg of caffeine. Following the introduction of these super caffeine sources, by 2006, worldwide energy drink consumption increased by 17% to 906 million gallons, and the market for them continues to grow exponentially. In the U.S., at least 130 energy drinks exceed the FDA-recommended limit of 0.02% of caffeine, and the FDA has not aggressively pursued manufacturers to seek compliance. As is true for AeroShot, the FDA does not require that these drinks contain warning labels. 

As bad as highly caffeinated drinks are on their own, they become even more dangerous when used in conjunction with alcohol. Binge drinkers may combine energy drinks (or most recently AeroShot) with alcohol or drink caffeinated alcoholic beverages in a misguided attempt to maintain their alertness and "sobriety." Unfortunately, when they do so, they are more likely to drive while intoxicated, become injured, or find themselves in dangerous sexual situations. The combination of alcohol and caffeine is becoming an increasing problem on college campuses. In one survey of undergraduates, over one-quarter reported that they had mixed alcohol and energy drinks in the past month; of these, almost half used more than three energy drinks at once (Malinauskas et al, 2007). 

Already a diagnosis in the International Classification of Diseases (ICD-10), the U.S. Diagnostic and Statistical Manual of Mental Diseases (DSM-IV-TR) includes caffeine withdrawal as a diagnosis requiring further testing. In the revision of the DSM being prepared now (DSM 5), caffeine withdrawal may be added as an official psychiatric diagnosis. The symptoms of caffeine withdrawal include headache, tiredness and fatigue, sleepiness and drowsiness, a pronounced sad mood, difficulty concentrating, depression, irritability, nausea, vomiting, muscle aches, and stiffness.

Whether or not a diagnosis is made, patterns of dependence and withdrawal associated with caffeine present a very real danger when overuse of caffeine threatens your health, your sleep, and your productivity. However, you don't necessarily have to be subjected to the negative effects of caffeine. Research on people's expectations about caffeine may lead to new ways of controlling people's dependence on caffeine by understanding and eventually challenging how they think about it. 

American University psychologist Dr. Laura Juliano, along with graduate student Edward Huntley (2011), explored the fascinating idea that caffeine expectancies may be as much as an influence on caffeine-related behaviors as the consumption of caffeine itself. In other words, it's not so much what caffeine does, but what you think it will do, that may be associated with how much you consume.

Huntley and Juliano developed a questionnaire to assess caffeine expectancies. From the responses of thousands of adults from across the United States, they concluded that the more people are led to believe that coffee will help them in their everyday lives, the harder it is for them to reduce their consumption to healthy levels. At the same time, the more they think caffeine will affect them negatively, the more they report that it does. People with high caffeine expectancy scores also had more symptoms of caffeine dependence and withdrawal. Coffee drinkers were the most likely to have strong caffeine expectancies, as did people who tended to have higher levels of overall anxiety. Controlling for the amount of coffee people drank, those who thought that caffeine would disrupt their sleep also had poorer sleep quality. 

Of course, in a correlational study, it's impossible to determine the direction of causality.  People with higher expectancies for positive or negative effects may have learned to develop these expectancies through their own caffeine-related experiences. There could also be a third factor influencing both expectancies and caffeine-related behavior.

The research also reinforced the findings that binge drinkers who combine alcohol and caffeine are more likely to be of college age. Nearly 1/5 of the alcohol drinkers in this study reported that they actually combine alcohol and caffeine to enhance their mood.  People under 25 had rates of alcohol-caffeine combinations that were twice as high as those for people 25 and older.  

The moral of the story is that if you want to reduce your need for what you believe to be caffeine's positive effects, you need to dial down your expectations of its benefits.

1. You are dependent on caffeine and would experience caffeine withdrawal without it. If you score high on this first factor, you think you need caffeine every day and would feel miserable if you didn't have it. You might expect that you'll get a headache and become anxious if you don't have caffeine. When you can't get the amount you'd like, you seek ways to get it.

2. Caffeine gives you energy and enhances your work ability. You believe that caffeine makes you more alert, energetic, better able to concentrate, and offers you a needed pick-me-up. If you don't have caffeine, you believe you'll be sleepier.

3. With caffeine, you can suppress your appetite. If you score high on this subscale, you rely on caffeine to help you control your feelings of hunger, skip meals, and avoid eating more than you should.

4. Caffeine improves your social relationships and your mood. You feel that caffeine can make you friendlier, more sociable, and happier. If you are a high scorer on this dimension, you think that you're a better conversationalist as a result of having caffeine.

5. Your physical performance benefits from caffeine. If you're high on this factor, you think that caffeine helps you work out more effectively, longer, and with greater enjoyment. You also think your athletic ability is enhanced.