The effect of dose expectancies on caffeine withdrawal symptoms during tapered dose reduction

Abstract

Background: Negative expectancies can exacerbate withdrawal symptoms via the nocebo effect. As such, information provided about dose reductions during attempts to taper a drug could contribute to withdrawal symptoms and increase the likelihood of relapse. The current study tested whether blinding participants to dose reductions during a supervised caffeine dose taper reduced these nocebo-induced withdrawal symptoms. Methods: Three groups of moderate to heavy coffee drinkers had their dose of caffeine reduced (tapered) from 300 mg per day to 0 mg over the course of five days and reported withdrawal symptoms twice daily. Groups were given differing information about how much caffeine they were receiving. An Open Reduction group was given accurate information about dose reductions. A Blind Reduction group was given no dose information whatsoever. A Deceptive Reduction group was misinformed about dose, with instructions suggesting that the dose remained on 300 mg for three days then dropped to 0 mg. Results: The Open Reduction group reported more pronounced caffeine withdrawal symptoms than the Deceptive Reduction group on the days with the greatest discrepancy between actual dose and informed dose, indicating a nocebo effect of open versus deceptive reductions. In addition, the rate of increase in reported withdrawal symptoms in the Blind Reduction and Deceptive Reduction groups was less than that of the Open Reduction group. Conclusion: These results suggest that awareness of dose reductions during a dose taper can result in a nocebo withdrawal effect, and that removing this awareness can reduce withdrawal. This has important implications for standard supervised dose-tapering practice, where patients are aware of the timing and magnitude of dose reductions.

Reduction in caffeine withdrawal after open-label decaffeinated coffee

“…The question remains whether the size of the reduction in withdrawal in the Open-Label group has practical significance. Based on average CWSQ scores reported by heavy coffee drinkers drinking ad libitum in other studies, the low range of the CWSQ caffeine withdrawal questionnaires is approximately 26 points (Mills et al, 2018), with a maximum of 92 points, suggesting a range of approximately 66 points between abstinence and regular consumption for moderate to heavy coffee drinkers (but likely less given that CWSQ scores of 92 points are extremely unlikely). Compared against this 62-point range, the Pre–Post reduction of 9.5 points in the Open-Label group suggests an open-label placebo withdrawal reduction effect of practical significance.…”

“…The maximum possible score for the 23-item CWSQ is 92 (for full questionnaire, see Supplemental Material 2). The CWSQ total score has demonstrated excellent internal consistency (α = 0.89, Juliano et al, 2012;α = 0.90, Juliano et al, 2019) and has demonstrated sensitivity to abstinence versus adlibitum caffeine consumption among regular users (Juliano et al, 2012;Mills et al 2018).…”

Hypnotic Discontinuation Using a Blinded (Masked) Tapering Approach: A Case Series

“…For example, a study of adult smokers found that participants reported greater reduction in nicotine cravings when informed that the nicotine-containing inhaler contained nicotine compared with when they were informed that the inhaler was nicotine-free, irrespective of the actual nicotine content (22). In a recent study of caffeine tapering, individuals assigned to a blinded tapering protocol reported fewer withdrawal symptoms than individuals assigned to open tapering where individuals were told their daily caffeine dose (8).…”

“…One factor that may interfere with dose reduction of a hypnotic may be discomfort related to withdrawal symptoms from pharmacological effects. However, pharmacological effects likely do not entirely explain the symptoms that patients report when tapering a hypnotic medication or similar agent (8). Negative expectations about stopping an agent have the potential to produce withdrawal symptoms (9).…”

Caffeine and Exercise Performance: Possible Directions for Definitive Findings

“…For each condition, the participants filled out a standardized questionnaire in accordance with self-reported measurements on the Withdrawal Symptom Questionnaire and Caffeine Craving for 24 h, showing that higher scores were correlated to the expected absence of caffeine consumption (Juliano et al, 2019). This nocebo effect due to the expectation of not consuming caffeine was also addressed in a study that performed the reduction of caffeine in habitual caffeine consumers, and it pointed out greater more withdrawal symptoms among the groups that had the perception of dose reductions during the taper dose (Mills et al, 2019).…”