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Definition and Validity of the Construct "Problematic Khat Use": A Systematic Review.
Awoke Mihretu1,2, Clement Nhunzvi3, Abebaw Fekadu4,5,6,7
1Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine Addis Ababa, Addis Ababa, Ethiopia, awoke.hm@gmail.com.
European Addiction Research
|April 17, 2019
Summary
Problematic khat use is defined by associated harms, increased frequency, and co-use of other substances, distinct from occasional khat use. Further research is needed to establish usage thresholds and develop culturally appropriate assessment tools.
Area of Science:
- Psychiatry
- Public Health
- Substance Use Disorders
Background:
- Problematic khat use is a significant public health concern, yet it is not fully established within current diagnostic frameworks like the DSM-5 or ICD-10.
- Existing reviews often conflate general khat use with problematic patterns, hindering targeted interventions.
- The lack of a clear definition and validation of problematic khat use necessitates further investigation.
Purpose of the Study:
- To systematically review and define the construct of problematic khat use.
- To differentiate problematic khat use from general khat consumption patterns.
- To identify indicators and validate existing measures of problematic khat use.
Main Methods:
- A systematic review following PRISMA guidelines was conducted, searching five major databases without date restrictions.
- Included studies defined, explored, evaluated, or measured problematic khat use.
- Data extraction and quality assessment were performed, with results presented via thematic synthesis.
Main Results:
- Thirty qualitative and cross-sectional studies were included, identifying harms, increased quantity/frequency of use, and withdrawal as indicators of problematic khat use.
- Frequent use (≥3 times/week) and concurrent use of other psychoactive substances were common defining criteria.
- Withdrawal symptoms included depressed mood, irritability, fatigue, and appetite changes. Existing measures showed acceptable construct, criterion, and convergent validity but lacked content, conceptual, and semantic validity.
Conclusions:
- Problematic khat use is characterized by harms, escalating use, and polysubstance misuse, differing from occasional, functional khat use.
- Establishing clear thresholds for problematic use patterns and developing culturally sensitive assessment tools using a bottom-up approach are crucial.
- Further empirical research is warranted to refine the definition and measurement of problematic khat use.