Conditions for Further Study 793
3. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for caffeine. 
b. Caffeine (or a closely related) substance is taken to relieve or avoid withdrawal
symptoms.
4. Caffeine is often taken in larger amounts or over a longer period than was intended.
5. Recurrent caffeine use resulting in a failure to fulfill major role obligations at work,
school, or home (e.g., repeated tardiness or absences from work or school related to
caffeine use or withdrawal).
6. Continued caffeine use despite having persist ent or recurrent social or interpersonal
problems caused or exacerbated by the effects of caffeine (e.g., arguments with
spouse about consequences of use, medical problems, cost).   
7. Tolerance, as defined by either of the following: 
a. A need for markedly increased amounts of caffeine to achieve desired effect.
b. Markedly diminished effect with continued use of the same amount of caffeine. 
8. A great deal of time is spent in activities necessary to obtain caffeine, use caffeine, or
recover from its effects.
9. Craving or a strong desire or urge to use caffeine.
A diagnosis of substance dependence due to caffeine is recognized by the World Health
Organization in ICD-10. Since the publication of DSM-IV in 1994, considerable research on
caffeine dependence has been published, an d several recent reviews provide a current
analysis of this literature. There is now sufficie nt evidence to warran t inclusion of caffeine
use disorder as a research diagnosis in DSM-5 to encourage additional research. The work-
ing diagnostic algorithm propos ed for the study of caffeine use disorder differs from that
of the other substance use disorders, reflecting  the need to identify only cases that have