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What constitutes problematic khat use? An exploratory mixed methods study in Ethiopia.

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|March 23, 2017
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Summary

Problematic khat use, defined by impairment, loss of control, and withdrawal, impacts mental health and functioning. User-reported indicators align with DSM-5 criteria for stimulant use disorders.

Keywords:
EthiopiaExploratory mixed methodsProblematic khat use

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Area of Science:

  • Psychiatry and Behavioral Sciences
  • Substance Use Disorders
  • Traditional Medicine

Background:

  • Khat (Catha edulis) is a psycho-stimulant herb with centuries of traditional use in East Africa and the Middle East.
  • While khat use is widespread, the specific characteristics of problematic use have not been systematically defined.
  • This study aimed to explore user perspectives on acceptable and problematic khat consumption.

Purpose of the Study:

  • To explore and define problematic khat use from the perspective of khat users.
  • To develop a framework for identifying problematic khat use based on user experiences and clinical criteria.
  • To assess the prevalence of problematic khat use indicators among users.

Main Methods:

  • Employed a mixed-methods (exploratory sequential) design combining qualitative interviews and focus groups with quantitative surveys.
  • Qualitative data (N=13 interviews, N=34 focus group participants) informed the development of a questionnaire.
  • Quantitative cross-sectional evaluation (N=102) utilized purposive and snowball sampling, analyzing data with descriptive and nonparametric statistics.

Main Results:

  • Khat use is socio-culturally acceptable for functional purposes, with implicit restrictions on amount, frequency, and type.
  • Problematic khat use was characterized by impairment in social/occupational functioning, loss of control, and withdrawal symptoms.
  • Among daily khat users (45.1%), common problematic indicators included loss of control (73.5%), continued use despite harm (72.5%), and avoidance of withdrawal (61.8%).

Conclusions:

  • Problematic khat use, despite perceived benefits, leads to impaired mental health and social/occupational functioning.
  • User-defined indicators of problematic khat use closely align with DSM-5 criteria for stimulant use disorders.
  • Findings suggest clinical and policy relevance, though larger studies are needed for definitive recommendations.