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Caffeine Use Disorder Survey

The Caffeine Use Disorder Survey is a questionnaire that assesses an individual's caffeine use and possible dependence. The survey consists of questions about an individual's caffeine consumption habits, including how much caffeine they consume and how often they consume it. The survey also includes questions about an individual's physical and mental health, as well as their social and work life.

2 minutes to complete

Eligibility

To be eligible to fill out the Caffeine Use Disorder Survey, an individual must be 18 years of age or older.

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Questions for Caffeine Use Disorder Survey

Questions

1.

How much caffeine do you consume on a daily basis?

The answer should be a text input.
2.

How often do you consume caffeine?

The answer should be a text input.
3.

What are the reasons you consume caffeine?

The answer should be a text input.
4.

Do you experience any negative side effects from caffeine consumption?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
5.

Do you feel like you need to consume caffeine in order to function properly?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
6.

Has your caffeine consumption ever interfered with your work or social life?

The answer should be a text input.
7.

Do you think you may be dependent on caffeine?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
8.

Would you like to cut back on your caffeine consumption?

The answer should be a text input.
9.

What are your thoughts on caffeine?

The answer should be a text input.

Scales Similar to Caffeine Use Disorder Survey

  • Caffeine Use Disorder Identification Test
  • Caffeine Intoxication Symptom Scale
  • Caffeine Withdrawal Symptom Scale

Here are some FAQs and additional information
on Caffeine Use Disorder Survey

What is the Caffeine Use Disorder Survey?

The Caffeine Use Disorder Survey is a tool used to assess whether someone is at risk for developing a caffeine use disorder.

Who can take the Caffeine Use Disorder Survey?

The Caffeine Use Disorder Survey is intended for use by adults 18 years of age and older.

How long does it take to complete the Caffeine Use Disorder Survey?

The Caffeine Use Disorder Survey takes about 5 minutes to complete.

What does the Caffeine Use Disorder Survey measure?

The Caffeine Use Disorder Survey measures symptoms of caffeine use disorder, including dependence and tolerance.

How is the Caffeine Use Disorder Survey scored?

There is no scoring for the Caffeine Use Disorder Survey. The survey is intended to be used as a tool to assess whether someone is at risk for developing a caffeine use disorder.

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