A highly popular drug of choice

Mugged: For millions of Americans, coffee -- in some form or other -- helps get them through the day.

June 07, 1999|By Jan Brogan | Jan Brogan,THE PROVIDENCE JOURNAL

PROVIDENCE, R.I. -- Having worked late the night before and facing another long day at the Trinity Repertory Company, Oskar Eustis, the theater's artistic director, begins the day at the Coffee Exchange, where he orders something called an ambulance chaser.

That's four shots of espresso in an oversize cup. Even the owner of the Coffee Exchange, Charlie Fishbein, considers it "going overboard."

Eustis, who drinks this concentrated version of coffee with just a touch of cream, explains: "I'm really, really tired from working hard, and this will keep me going for the rest of the day."

Eustis jokes about being addicted to coffee, exaggerating for effect: "I'm not proud of being addicted to caffeine, but it's a sacrifice I make for my work and the city of Providence."

But in truth, Americans are addicted to coffee. On a typical day, according to estimates from the National Coffee Association, 49 percent of the population must have a cup.

"Coffee is the most widely used mood-altering drug in the world," says caffeine researcher Roland Griffiths, a professor of psychiatry and neuroscience at the Johns Hopkins University.

For most people, caffeine use is relatively benign and, in some instances, beneficial. Although there is some controversy about health risks, Griffiths says, "a balanced reading of the medical literature suggests that caffeine is not putting anyone's life in danger."

But is it addictive?

If you define an addictive drug as one that induces daily habitual patterns of self-administration and physical withdrawal symptoms in those who try to give it up, then, yes.

But if you define an addictive drug as one that often leads to high-dose escalation or as an abused substance that wrecks families and lives, then, no.

There is a big difference between coffee's active ingredient, caffeine, and other mood-altering drugs such as cocaine or alcohol.

Jean Manning, a 23-year-old restaurant manager, sits at a table on the patio of the Coffee Exchange and drinks an iced coffee with her bagel.

Manning, who admits to drinking six or seven cups of coffee a day, says she drinks coffee to wake up in the morning, but she also drinks it with lunch and dinner, and at 10 at night, when she is at work.

Besides helping to wake her up, coffee makes her feel a little sharper, makes her responses a little quicker.

A stimulant

Caffeine stimulates the central nervous system, making people feel more awake, alert, productive and generally upbeat. Studies have shown that as little as a third of a cup of coffee helps people pay attention to extended tasks, like driving, and can help sharpen moderately complex mental skills such as recognizing words and manipulating numbers.

Caffeine can even improve athletic performance because it fights muscle fatigue by releasing free fatty acids in the body. Fatty acids can be used as an energy source, saving sugar in the muscles for later. This can prolong the body's ability to endure exercise and long periods of physical labor.

But it takes very high levels of caffeine to produce a competitive improvement in athletic performance -- levels deemed illegal by the International Olympic Committee.

And too much caffeine can cause a host of unpleasant symptoms.

At high levels, people can develop a syndrome called coffee intoxication, according to Dr. Vincent Marcaccio of Roger Williams Medical Center in Providence. Drinking four or five cups a day, or more, can cause irritability, muscle twitching, rambling speech and thought or troubles with sleep.

A recent study by researchers at Duke University Medical Center found that drinking four or five cups of coffee in the morning can produce effects that last until 10 at night.

Pam Young, a young mother and artist in Providence, drinks only two cups of coffee a day but says she got a splitting headache when she drank decaffeinated coffee by mistake. (Indeed, nearly everyone interviewed at the Coffee Exchange volunteered an experience with the dreaded withdrawal headache.)

Withdrawal pains

Such headaches are the most pronounced symptom of caffeine withdrawal. But some people become depressed, anxious, fatigued or even nauseated.

Symptoms, which can last up to a week, often appear 12 to 24 hours after the last dose of coffee -- so some of the alertness and sense of improved well-being that comes with the morning's first cup of coffee is caused by the relief of withdrawal symptoms.

Through the years, studies have linked even moderate caffeine use to hypertension, abnormal heart rhythms, miscarriages, premature birth, stomach ulcers, osteoporosis, fibrocystic breast disease and even cancer, but newer research refutes many of these earlier findings.

Other studies, some paid for by the coffee industry, have found benefits from caffeine. These studies show that caffeine can help lift depression or manage alcoholism. A recent study by a professor at Harvard University found that four to five cups of coffee a day may reduce the risk of colorectal cancer by 24 percent.

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