Every morning, more than half of all people in the United States start their day with a simple, innocuous beverage: coffee. Served in a cup or from a drive-thru, in a mug or a thermos, the average drinker consumes about three cups each day, according to the National Coffee Association. The stimulating effects of the drink seem to kick in after a few minutes, with coffee drinkers feeling more awake, more energized, and ready to tackle their day with just a simple drink in their system. What many don’t realize, however, is that the benefits of coffee consumption may come with serious side effects.

Caffeine is legally classified as a drug by the Food and Drug Administration (FDA) and is a stimulant, scientifically defined as any chemical that increases the rate of activity in the body’s central nervous system (CNS). The CNS includes the brain and spinal cord, which are responsible for thoughts, emotions, muscle movement, and more. Stimulant drugs work by making the brain and spinal cord more active, allowing users to feel more awake and alert. Other commonly-used stimulants include well-known addictive drugs such as cocaine, methamphetamine, and nicotine. Research about using caffeine to treat addiction shows that caffeine has similar addictive and stimulating effects, with higher doses of caffeine being comparable to average doses of cocaine and other various amphetamines. 

Caffeine addiction also has severe health consequences. Caffeine has been implicated in increasing rates of hypertension, cardiac problems, pregnancy risk, anxiety disorders and insomnia in the United States. According to a study by the University of Florida, around 35 percent of coffee drinkers met the requirements for addiction or dependence in the 4th edition of the American Psychological Association’s DSM-5, the official collection of scientific information used by healthcare workers to diagnose substance abuse disorders in the United States. 

Though caffeine is the most common drug consumed by the average person in the United States, it is far from the most addictive. In addition, caffeine is legal for a reason, and generally safe or even healthy to consume in moderation (key word, moderation – caffeine overconsumption can be deadly, as demonstrated in the Panera charged lemonade scandal). 

Caffeine’s cousins in the stimulant family of drugs — methamphetamine and cocaine— are both far more addictive and far more dangerous to use. And, though nicotine is technically legal to purchase in the form of cigarettes, vapes, and other nicotine-containing products, commercial law requires these products to be very clearly labeled as extremely addictive due to their nicotine content. 

Substance abuse is a very real and dangerous problem in the United States, especially among teenagers. One in seven Americans reports struggling with a substance abuse disorder of some kind according to the Centers for Disease Control (CDC). According to Caron, a drug rehabilitation center for both teens and adults, 86 percent of teens know someone who drinks, smokes or abuses drugs during school. By the time that they reach twelfth grade, almost fifty percent of high schoolers report that they have used illegal drugs. 

The US Department of Health and Human Services also found that 46.3 million people aged 12 or older (or 16.5 percent of the population) met the applicable DSM-5 criteria for having a substance use disorder in the past year, including 29.5 million people who were classified as having an alcohol use disorder and 24 million people who were classified as having a drug use disorder.

The effects of severe substance abuse vary based on what the substance is, but common symptoms include substance cravings, withdrawal and loss of self-control. Differing drugs have different associated physiological symptoms as well. For example, nicotine addiction is often accompanied with incredibly severe withdrawal symptoms such as headaches, nerve pain, and in rare cases, seizures, while methamphetamine addiction over time often leads to extreme weight loss and fits of uncontrollable emotion. 

But what makes stimulants and other drugs addictive, and why does overuse harm the body? 

Drug addictions often become hard to quit because they fundamentally alter the brain’s chemistry. Addictive substances mimic signaling molecules (called neurotransmitters) in the brain that are responsible for various behaviors, ranging from motivation and happiness to appetite and reaction time. The body has a carefully regulated and natural chemical system that keeps behaviors and emotions in balance. Introducing outside chemicals into the brain often throws this system into disarray, drastically altering brain function. 

Illicit drugs work by manipulating the brain’s reward pathways, mimicking neurotransmitters that are responsible for emotions and behaviors. In the case of cocaine usage, cocaine elevates levels of dopamine (linked with pleasure and reward) in the brain. Usage of cocaine rewards addicts with melty, hazy feelings of elation, which further reinforces the behavior. But over time, the brain begins to adapt to the high levels of artificial chemicals, and regular users become much less sensitive to the drug, due to what scientists call neuroplasticity. Eventually, cocaine begins destroying the body’s natural dopamine processing, leading users to take more and more of the drug to achieve the same effects. This cycle can eventually lead to extreme anorexia, depression, and even overdose. 

Other drugs function based on similar principles. Caffeine blocks the function of adenosine, a neurotransmitter involved in sleep and feelings of tiredness. Highly addictive nicotine interferes with acetylcholine –responsible for learning and memory– and has been linked to impaired brain development in teens. Heroin and other illegal opioids induce euphoria by blocking the body’s natural opiates, which are responsible for alertness, reward, and happiness. Over time, heroin users lose the ability to naturally produce opiates, which can lead to depression, seizures, and once again overdose, with the U.N. World Drug Report and Behavioral Health Centers finding that opioid overdose deaths have quadrupled since 2000. Drug addiction is a major risk factor for suicide according to the National Institute of Health, and opioid abusers are thirty-five to fifty percent more likely to have an anxiety or mood disorder than the average person.

But, how do you spot the signs of substance dependency before it’s too late, either in yourself or in someone else? The DSM-5 identifies a several groups of symptoms as indicative of a substance abuse disorder, including: 

• Withdrawal and cravings. 
• Increased tolerance  
• Sacrificing time and money to feed substance abuse habits. 
• Lack of self-control and an inability to quit. 
• Social interaction problems, such as with family or friends 
• NOTE: If a person has even two of these symptoms, they qualify as having a substance abuse disorder as defined by the American Psychological Association.

If you are part of the 86 percent of teens who know somebody that drinks, smokes, or abuses drugs during school, or if you are struggling with substances, there are ways to get help:

• Boston Children’s Hospital has developed the CRAFFT test, a clinician-developed test to ensure the well-being of children and adolescents by identifying substance abuse risk factors. Taking it may give better insight into the feelings that you or a loved one may be experiencing about substance abuse, and may give takers an idea of where to start. 
• The US Department of Health and Human Services has a hotline at 1-800-662-4357, which is a confidential line that allows callers to find accurate information about substance abuse and proper, safe treatment. 
• The Department of Health and Human Services website has several documents and mobile apps that document the dangers of substance disorders, as well as how to combat substance misuse, identify common mental health conditions, and cope with disasters and other traumatic events.
• The CDC has an official website which details the dangers of substance overdose, as well as how to recognize it and offers possible therapy methods. 
• The National Institute of Drug Abuse has an interactive website featuring videos, games, blog posts and more that delivers the latest scientific news on how drugs affect the body.  
• A comprehensive list of resources for both teens and their parents is available at https://teen-safe.org/resources, along with available resources and hotlines. 
• For those struggling with suicidal thoughts or family issues related to addiction, the National Federation of Families and the National Association for Children of Alcoholics have specific resources such as counseling and outreach opportunities available for teens. 
• Washington’s TeenLink provides another comprehensive list of resources for how to get started, and has specific resources for teens, parents, doctors and teachers. 

Above the Influence has informative resources and facts about drug abuse, how to combat it, and advises teens about how to avoid social situations and peer pressure that may lead to drug abuse.