by UniverseHacker | 2025-12-06 19:36:18+00:00
> I'm flabberghasted by your interpretation. Could you please try to support this interpretation with quotes? I can't even begin to understand how to converse with this point of view since such a POV does not exist in the lancet article.

It's hard for me to know where to start, because I feel similarly confused about where you might be coming from, and I don't know your level of background in reading and interpreting biomedical papers. However, I can elaborate a bit on my thinking and mention that I am an academic biomedical researcher that reads, publishes, and peer reviews biomedical papers - but I am not a psychiatrist or medical doctor. This is not my field of expertise, I'm not trying to argue from authority, just mentioning where I'm coming from.

First, for context, this correspondence article is in The Lancet Psychiatry, so is targeted at psychiatrists, and is able to avoid a lot of background that they can safely assume the reader already has, like the diagnostic criteria for common conditions.

You are using the term "chemically addictive," which is not used in the article, and which is a term that simultaneously implies both "physical dependence" or "substance dependence" and "addiction" from back when the two were mistakenly assumed to be one in the same. This article is emphasizing the fact that they aren't the same thing, and both can exist independently of one another. Since that is really the only singular point in the article, and is really hammered home over and over, I cannot see how pulling out quotes would help. I think our disagreement comes from the surrounding context not mentioned, not the contents of the article itself.

The article describes that as of the DSM-5 they directly address the confusion between the two, and separate them into two entirely different things. While not explained in the article, it is important to realize that the DSM-5 now includes behavioral addictions together with drug addictions, and considers physical dependence and/or other types of direct chemical modulation of the reward system to be a contributing factor in many cases, but not essential, for addiction.

This distinction is extremely important, because it allows for addiction without substance dependence to be taken just as seriously, and properly treated and addressed clinically or by other means.

Previously, because of the history of this mistaken connection, psychiatrists and patients would wrongly dismiss (as you are with caffeine) the possibility of serious addiction without a direct chemical dependence mechanism. This left people whose lives were being destroyed by things like gambling and sex addictions to be dismissed as not serious, and not allow them to get real help. On the flip side, it also made doctors wrongly afraid to administer drugs that caused chemical dependence but not addiction, for fear that it would lead to addiction in patients.

However, I would argue that while addictive, the level of addiction potential from caffeine is pretty limited because of the fact that it has pretty severe adverse/toxic effects if you take too much, and the enjoyable aspect saturates out pretty quick. Taking a lot more than a normal amount, enough to damage your health, feels awful, so people aren't likely to become addicted to doing so. Counter-intuitively, the most addictive drugs have low acute toxicity and so you can take increasingly huge doses of them and it continues to feel good rather than just make you uncomfortable and sick like a high dose of caffeine.