DSM-IV did not include caffeine dependence despite preclinical research literature because clinical data were lacking (155). Relatively small-sample clinical surveys published since then and the accumulating data on the clinical significance of caffeine withdrawal and dependence support further consideration for a caffeine use disorder (152, 153, 156–160), particularly given concerns about youth energy drink misuse and new alcohol-caffeine combination beverages (161, 162). However, clinical and epidemiological studies with larger samples and more diverse populations are needed to determine prevalence, establish a consistent set of diagnostic criteria, and better evaluate the clinical significance of a caffeine use disorder. These studies should address test-retest reliability and antecedent, concurrent, and predictive validity (e.g., distress and impaired functioning).
