Mindfulness and Harm Reduction in Addiction—The Caffeine Example

This post is a response to What Caffeine Really Does to Your Brain by David DiSalvo

Whenever people can be shown how any mood-affecting substance affects their brains, it becomes easier for them to comprehend the thing can be addictive. Which is funny, since you’d think they’d have appreciated addiction through the simple observation of a substance’s effects on their lives and on the lives of the people around them. But perhaps that’s hard to do on its own (like those tribes that don’t comprehend the connection between sexual intercourse and pregnancy).

It’s hard for many to comprehend caffeine is addictive because, well, coffee-drinking is normal. So David DiSalvo’s exploration of how caffeine affects the brain in the course of his kicking his addiction to coffee raised a predictable surge of interest among those combating caffeine addictions and coffee’s negative effects.

At this point, I’ll take a side trip to describe some mind experiments I do with audiences around nicotine and caffeine. I ask them what the 1964 Surgeon General’s Report, Smoking and Health, said about smoking’s addictiveness. No one now recalls that the 1964 SGR said smoking was not addictive, but habituating. Nicotine’s addictiveness wasn’t officially recognized until 1988, when a separate SGR characterized nicotine as addictive. (I recognized it as such in 1975 in Love and Addiction.)

When I ask audiences why this was true, they shout out in unison, “Because the researchers were in the tobacco industry’s pocket.” Really? A group of investigators who declared that smoking causes cancer leading to a precipitous drop in smoking in the U.S. were tobacco company hacks?  That makes no sense whatever. But people can’t grasp that the meaning of addiction changed, and continues to change.  It took until the 1980s for the body of scientific and popular opinion to accept that a legal, non-intoxicating substance could be addictive like heroin was.

Then I ask—”What if coffee were found to cause cancer, like tobacco—how would people react?” I propose that the same kinds of reactions that followed the 1964 SGR in the case of smokers would occur in the case of coffee—some habitual drinkers would quit instantly, some would struggle and quit, some would struggle and not be able to quit, and some would just pursue their addiction full steam ahead.

Let’s return to DiSalvo’s post, some commenters on it, and America’s abstinence fixation. First, let’s do another mind experiment. What percentage of alcoholics enter treatment or join AA? We know from NESARC that number is 12.5 percent. Let’s round to 10 percent. Then, what percentage of those exposed to AA or alcohol rehab stick strictly to their regimens and continue with AA? The answer is probably fewer than 10 percent, but let’s say 1 in 10 do. Where’s that leave us? With one in a hundred succeeding at AA and rehab and following their ironclad precepts.

Nothing daunted, however, we insist that all alcoholics and drug addicts join a 12-step group and/or go to rehab and never drink or use again. That’s America’s abstinence fixation. In real life, people track back and forth, generally improving. NESARC found, for instance, that three-quarters of alcoholics achieve full recovery (and no higher a percentage of those who’ve been in treatment than those who haven’t), and that more than half in full recovery continue drinking, along with quite a few who improve without achieving full remission.

That’s reality.

How do people react when they learn that they may be addicted to caffeine?  Do they feel they absolutely must quit? There are some indications that they are less crazed by America’s abstinence fixation—in other words, you won’t be run out of town on a rail for trying to reduce or moderate your coffee intake. (I recall with amusement how behavioral psychologists Peter Nathan and Barbara McCrady warned that psychologists who insisted on helping alcoholics moderate their drinking could end up in prison.)

Let’s turn to caffeine addicts’ stories in response to the DiSalvo post.

Here is Amanda Williamson’s:

Caffeine free for 3 years: I gave up after a trip to the States. My husband and I were so used to our homemade, morning capuccino. American coffee makers do not make very nice coffee, so finding a decent coffee was a mission every day, and we were grumpy until we got that fix. We ended up scouring shops trying to find a moka pot and handheld milk frother. This seemed rather desperate.

Okay, I can’t resist making a couple of jokes: 1) our lousy coffee serves a purpose! 2) Amanda caught abstinence fixation in America! I couldn’t resist pointing out to Ms. Williamson in a response to her comment that coffee drinkers live longer. Before I describe her reactions to my observation, let me first note the limitations on her own abstinence prescription:

Sadly, my husband went back to caffeine when he started working in an office where they drink tea and coffee all day. At the weekend, if he doesn’t get his fix, he is grumpy and agitated. But he doesn’t see it. He thinks he is fine. The tetchiness seems to ease off when he gets his coffee.

I feel a joke coming on: Another marriage ruined by an asbtinence fixation!

Here’s what Ms. Williamson thinks of me, coffee’s life-prolonging effects, and her abstinence fixation:

Regardless, the study shows preliminary evidence that there may be a correlation between coffee drinking and longevity of life. There’s a whole lot more to the research than taking a little snippet as you have done. Maybe you are an ardent caffeine consumer who’s so hooked that you only see the parts that support your habit (me and Amanda’s husband both—perhaps we can form a support group). I know I’m going to die and I know that looking up research about my various habits is probably futile in affecting that.

Go get ’em Amanda!

Commenter Melly quit entirely, but:

When I visited my parents months later and participated in my dad’s daily coffee habit for a few days, I realized that I’d forgotten what it did for me (or maybe I had previously become too dependent on its chemistry, as you say, and the effects declined to unnoticeable levels). Regardless, I reexperienced the lovely kick it can give me that makes emerging from bed and sitting down to work seem not an impossible proposition. I now think that quitting it was the silliest thing I’ve ever done.

So by quitting for a time, Melly realized how pleasurable coffee could be. Can she make use of this realization in her coffee-drinking habits?

Now, for Kathryn:

I quit a 2 year, 2 cup a day habit (I’m highly sensitive, didn’t take much to mess with me) after my PMS symptoms started bordering on psychotic. After quitting, my next cycle snuck up on me with absolutely no symptoms whatsoever and I felt much better all around. I had eliminated all caffeine, save for about 1/4 tsp chocolate syrup in milk occasionally. I began toying with decaf coffee, tea, chocolate and discovered that anything more than a very minimal amount, and only once in awhile, would bring back my symptoms of anxiety and irritablility, and a general mental fogginess.

Abstinence fixators will undoubtedly pick up on Kathryn’s “anything more than very minimal amount, and only once in awhile”. . . .  Kathryn’s in denial! She thinks you can titrate the poison to which you are addicted! She’s doomed, doomed!

I’m exaggerating, joking again. Kathryn is doing what normal human beings do until they become convinced that their addiction is a chronic brain disease—they try to lower their consumption level of something they can enjoy (even benefit from) to a point where they can savor its positive effects without experiencing, or by reducing, the negative ones. And they often make headway, even when it is a hesitant, back-and-forth process as it has been for Kathryn. That’s harm reduction. Mindfulness is being mindful of this process, as Kathryn did by becoming aware of when and in what amounts caffeine has a negative impact for her.

Fixators—have at me! (Don’t forget the key anti-harm-reduction phrase in the abstinence-fixation armory: “Hijacked brain.”)