Caffeine Dependence

Johann Sebastian Bach's satiricalCoffee Cantata, using a libretto by the Leipzig poet Picander, reflected the controversy about coffee drinking that existed in early 18th-century Europe. Concerns that coffee drinking can become a pernicious habit, whether due to its enticing aroma and flavor or its modest psychostimulant effects, date back to at least the 16th century. Only much later was it discovered that the stimulant effects are from caffeine, a methylxanthine compound that, in various forms, has become the most widely used psychoactive substance in the world. Can use of this substance lead to dependence? If so, what are the implications for physicians and the public? See also p 1043. In this issue ofThe Journal, Strain et al¹report the results of a small but carefully performed study indicating that some persons can be found who meet criteria for substance dependence with reference to caffeine. A previous study