Academic journal article The Journal of Rehabilitation

Caffeine Consumption and Disability: Clinical Issues in Rehabilitation

Academic journal article The Journal of Rehabilitation

Caffeine Consumption and Disability: Clinical Issues in Rehabilitation

Article excerpt

The consumption of caffeine may at first seem to be of minor importance when compared to the many variables which influence the lives of rehabilitation clients. However, abuse of caffeine in our society is so common that its effects are often overlooked or disregarded. Rehabilitation professionals who have a responsibility to plan holistic and comprehensive rehabilitative services should consider the potential impact of caffeine abuse. In simple terms, ingestion of too much caffeine can have negative consequences on the health and well-being of the rehabilitation client.

Accordingly, caffeine abuse can undermine rehabilitation planning, can exacerbate existing disabling conditions, and can generate new symptoms which may lead to misdiagnoses. This article describes the life-impact that caffeine can have on human beings, specifically those with disabilities. The article seeks to explain the need for rehabilitation counselors and other professionals to evaluate clients' caffeine intake to determine the effects it may have on rehabilitation outcomes. Toward that goal, the impact caffeine use can have upon the accuracy of professional assessment and evaluation of the client's life-situation should be taken into account. Conclusions from such evaluations form the basis for subsequent rehabilitation planning and services. To a large degree, the success of the entire rehabilitation process may be governed by the accuracy of such evaluations.

Pharmacological Aspects

As a chemical, caffeine is a methylated xanthine, a powerful central nervous system (CNS) stimulant which can arouse all levels of the brain and the skeletal muscles (American Pharmaceutical Association, 1979; Liska, 1986; Ray & Ksir, 1990). Within thirty minutes after ingestion, caffeine peaks in blood levels and affects the CNS. It reaches its maximum effect in two hours. Caffeine has a half-life of approximately three hours; less than ten percent leaves the body unchanged (Ray & Ksir, 1990).

A regular cup of coffee may contain as much as 150 mg of caffeine, while soft drinks generally contain about half that per can. About 200 mg of caffeine will activate the cortex, cause an arousal pattern on an electroencephalogram (Liska, 1986; Ray & Ksir, 1990), and decrease fatigue and drowsiness (Ray & Ksir, 1990). A dosage of five to six hundred mg of caffeine a day presents a significant health risk (James & Stirling, 1983). Such pharmacological action may exacerbate disabling conditions which can lead clients and professionals alike to confuse new symptoms from this drug use with symptoms of disability.

Although caffeine dilates coronary arteries and increases peripheral circulation, it constricts blood vessels in the brain (Liska, 1986). Ironically, the subjective experience of such physiological changes may encourage some individuals to self-medicate with caffeine as a way of coping with the adverse physical effects. In reality, however, this self-medicating may only serve to perpetuate or worsen the physical impact of abuse.

Caffeine stimulates the muscles of the heart (Liska, 1986; Ray & Ksir, 1990) and can cause palpitations and tachycardia (Victor, Lubetsky, & Greden, 1981). Excessive use can cause premature ventricular contractions (Greden, 1974; Greden, Victor, Fontaine, & Lubetsy, 1980). Caffeine can render antihypertensive medications ineffective (Lane, 1983) because it increases blood pressure (Lane, 1983; Liska, 1986; Ratliff-Crain, O'Keeffe, & Baum, 1989). Rehabilitation counselors, therefore, should be particularly alert for caffeine abuse in clients suffering from cardiovascular disorders or essential hypertension.

It has not been fully determined if caffeine precipitates coronary heart disease. LaCroix, Mead, Liang, Thomas, and Pearson (1986) predicted that men (non-smokers) who are heavy coffee drinkers have a two to three times greater risk of developing coronary disease because of their caffeine intake. …

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