Perception with khat chewing
The study also explored the perception of youth regards to the habit of chewing khat, perceived benefits of khat, perceived harms of khat, and perceived consequences of quitting khat.
Perceived factors for the habit of chewing khat
The major contributing factors reported for chewing khat were personal factors like: as a means to be relaxed, to enjoy with friends, to spend free time (kill time), to forget worries and manage stress, self-treatment from depression and to be active and energetic at work. Many emphasized recreational purpose of khat use, to be active and energetic during academic study. The experience of two respondents summarize as follows:
‘I started chewing khat with my friends to be relaxed, enjoy, spend our leisure time and get out of a boring situation.’ (IDM-05, age 23)
‘I started chewing with my friends, to know and want to taste and experience its effects then we continue chewing.’ (FGM -15, age 19)
In addition to personal factors, participants both in the in-depth interview and FGD were asked about the reasons how they started chewing khat, and they reported different factors such as the influence of their peers, learning from older adults and family members, easy accessibility, and absence of alternative youth focused recreational places. For example, one of the participants stated as:
‘I started chewing to relate with my friends otherwise I will be alone. One day, they were chewing khat and gave me few sticks of khat and showed me how to chew. That’s how I started chewing.’ (IDM-03, age 22)
A 21-year-old boy also described the role of adult’s influence for introducing khat use.
In the countryside there was a ceremony called "Du'a"-prayer among elderly people. I usually attend the ceremony and I started chewing khat there with them.’ (IDM-02, age 21)
Similarly, the participants of the FGDs also emphasized the role of peer pressure as illustrated below by the quote from one of the participants:
‘I remember how I chewed khat for the first time. Some of my friends used to chew khat just in the place I used to spend my time, and I started it by seeing them. Then after I tasted it once, I also become a regular user until now.’ (FGM-10, age 22)
Regarding environmental factors, participants also explained that khat is publicly soled as well as planted in the farms by which it is easily accessible for youths to taste/experiment. One participant interviewed supported the provided the explanation in the following way:
‘When I was in the countryside, all the farms were covered with khat, and our families and relatives were sellers of khat. So, we observed people buying and selling khat, and it was accessible easily. Then, I tried it and started in a small amount there.’ (IDM-01, age 24)
Participant’s perception with khat
This is a salient finding in the understanding of the participant's perception regards to the habit of chewing khat. In this study, youth’s perceived khat from the perspective of experienced effects and intended benefits. For instance, it was perceived as a means for happiness and as an antidepressant, which helped them to be relaxed, free from tension and stressed situation and also considered as an entertainment. Furthermore, khat was also seen as something like a drug that makes someone alert, active, energetic and then depressed. To illustrate these, one of the participants described the situation as:
‘For me, khat is something like a drug, but helps for spending time, to be enjoyed, to be free from tension and stressed situation. It is just an antidepressant ‘ድብርት ማስለቀቂያ’’ (IDM-05, age 23)
However, khat was also described as something basic like food which someone needs to do a job. It is also considered as a catalyst for many other things such drinking alcohol, smoking cigarettes. One of the participants illustrated this as follows:
‘Khat is something basic like food for me. It is also like a drink- ‘Ambo-wuha' [sparkling mineral water] which you take while eating. You just chew to satisfy your need and be comfortable then you will be relaxed and do your routines. So, I take it as one of the basic things needed [for me] during the afternoon. Unfortunately, khat is also a catalyst to many things. For instance, it pushes you to drink alcohol and smoke cigarettes.’ (IDM-03, age 22)
On the other hand, participants also mentioned khat as part of the community's traditional practice which is commonly used [by the community] and given to them [the youth] as illustrated by the following quote:
‘It is a cultural tradition and most people, including our fathers, use it for positive purposes such that they become positive thinkers and wish to a good thing for others. For instance, they pray to those who do not have jobs to help them get what they wanted, and they also pray to all things in the world.’ (IDM-01, age 24)
‘I See khat as a part of a tradition in the community which is transmitted from generation to generation, and that is what we observed when growing up. So, now it's just like a cultural practice that is common among teachers, schools or universities and communities. Therefore, I used khat because my community gave it to me, made me use it, and I said it is part of our culture.’ (FGM-09, age 23)
However, a few FGD participants also described khat as parts of a life trajectory that everyone should pass through and taste it.
Perceived benefits of khat
The study also enquired about the perceived benefits of khat among individual respondents and FGD participants. It was described from a different perspective such as participants pointed out that khat helps someone not to be easily fatigued when working, and it also helps to forget worries. Participants also mentioned that khat was beneficial to solve serious issues or to help one another by creating an opportunity to discuss together, to get fun, and to strengthen social relationships accordingly. One of the participants described these:
‘Let me give you an example, our mothers come together in the traditional coffee ceremony for different purposes, like to have fun, for discussing serious issues, and to help one another. If one of them faced a problem, they solve it through discussion while drinking coffee. The same is true for men or among our fathers. Everyone brings their khat, come together and discuss the same as our mothers. Therefore, khat is beneficial to discuss together and strengthen the social relationship.’ (IDM-01, age 24)
Similarly, some participants in the FGDs also raised that khat was useless, but its benefits were temporary. It had a cyclical effect. A 19 years old FGD participant explained this:
‘I can say khat has benefits, but its benefits are temporary. When we see someone doing a task using khat and doing without chewing khat, they are not the same. You work more actively and get inspired when you chew khat. So, I have got a lot of benefits from khat just like I can do my works and achieved it when I chew, but I become very weak and depressed at night.’ (FGM-12, age 19)
Perceived harms of khat
In this study, an attempt was also made to explore the negative experiences of participants from khat chewing. Most of the respondents stated that khat causes physical harm (loss of appetite, drying of the mouth, intestinal and kidney problems), economical problem (spend a lot of money), relationship problems, and low self-esteem.
It was reported that the habit of chewing khat causes loss of appetite which also causes weight loss, drying of the mouth, intestinal constipation, and urine retention which also causes kidney problems. Here are two respondents explained the experienced effects of khat:
‘Yes, khat hurt me in many ways. I lost weight because I usually don’t have appetite for food after khat use. It also causes constipation, gastric pain and drying of the mouth.'' (IDM-05, age 23)
The effect of khat on the economy was also raised by the respondents of the study. One of the respondents described the economic impacts of khat as:
‘If you take my experience, it has been 8 years since I started khat. So, when you calculate these years by 50 Birr [daily budget for khat] plus other additional costs like water and sprite (soft drink), it's too much expense. I would have been rich if I had saved this money that I spent on khat.’ (IDM-06, age 24)
Again, the study participants reported that the habit of chewing khat causes psychological effects like confusion, poor self-care, low self-confidence, and low self-esteem. One female respondent said;
‘‘Once, you become addicted to khat, you don’t care about your protocol or self-care.’’ (IDF-04, age 19)
A 17 years old boy also reflected his views as:
‘It causes a lot of harm. First, it lowers your self-confidence and you look yourself as inferior or feel below other persons. (FGM-13, age 17)
The study also revealed the effects of khat on social relationships. It was reported that khat affects one's relationship with families as well as the entire community. It causes failures in fulfilling social duties and leads to conflict with families. These were described by one of the female respondents as follows:
‘The worst thing I face was that I cannot go home after chewing khat because my families nagged me. Then, I would go home late at night and even spend the rest of the night drinking alcohol after the khat. So, this behavior will lead to conflict with your families. Then, the community will undermine you because they suppose you to respect and have good relationship with your families.’ (IDF-04, age 19)
This was also explained by 23 years old FGD participant as:
‘Khat makes me isolated from people because I don’t want to contact people after chewing. For example, there was a situation of mourning in our neighborhood, but I could not go there because I was chewing. Later, my relationship became terminated.’ (FGM9, age 23)
Perceived needs of treatment for khat users
This study had also explored the perceptions of youth regarding the needs of treatment for khat users. Most of the respondents believe that there are khat users who need treatment. As per the information gained from the respondents, those who chew khat the whole day through the night, since they haven't got enough rest, will be vulnerable to other problems. Those who are addicted to khat and cannot do anything without it would also go for modern treatment. Moreover, those exposed to health problems like intestinal constipation and gastric problems as a result of chewing ware not eating well were among the candidates for treatment. Those who are polysubstance users such as drinking alcohol and smoking cigarette or ganja (cannabis) were perceived in need of treatment. Supporting this view one of the respondents described the needs of treatment for khat users as:
‘Some youths chew khat continuously and use other substances such as smoke cigarettes, ganja (cannabis), and drink alcohol, and this leads them to do unsafe sex and commit a crime. When they become high (stimulated), they don't know what they are doing. So, these guys should be helped with treatment.’ (IDM-05, age 23)
Similarly, this was also mentioned in the FGD as reported in the following way:
‘I believe there are khat users that need treatment, especially those who are addicted and those who haven't teeth that use ground khat should need treatment.’ (FGM-12, age 19)
Participant Treatment Experiences related to khat
The study also enquired about the professional treatment experiences of khat users and was triangulate by key informants (mental health professionals). It was found that most of the respondents had no experience and did not sought professional treatment for khat. Health professionals said that khat users would manage the effects of khat by themselves. They also added that the personal belief - ‘khat is a cure for different health problems by itself’ might be the reason for youths not to seek treatment. On the other hand, participants also reported that they saw khat users who visited their health care facilities by those who seek help for khat associated medical problems such as gastric problems, constipation, and problems related to appetite loss.
Similarly, key informants (mental health professionals) also confirmed that they had no experience or did not see clients who seek treatment specific to khat use. They only saw khat users with comorbid with other psychiatric problems such as schizophrenia, mood disorder, depression, and anxiety disorder.
Perceived Coping Measures for the effects of Khat
This study also revealed different perceived measures for reducing the effects of khat through probing systematically. Respondents reported taking various measures to manage the effects of khat at different consumption times such as measures taken before consumption of khat, measures taken during consumption of khat, and measures taken after consumption of khat.
Coping techniques before chewing the khat
These were perceived measures taken before chewing to prevent and reduce the adverse effects of khat. Loss of appetite was reported adverse effect of khat and to minimize this effect, feeding well before chewing was an alternative measure taken by khat users. Below is one of the respondent's experience:
‘I had never sought treatment due to khat because I eat properly, and I had balanced myself with the khat by eating well because at night [after chewing khat] you might not eat.’ (IDM05, age 23)
Similarly, participants from group discussion also perceive eating well in morning and lunchtime before chewing as one of the means to fill gaps in one's daily calories or to compensate for the appetite loss which occurs after chewing.
‘Khat has problems, it causes loss of appetite at night to me, so, I eat my meals in the morning and daytime.’ (FGM-08, age 23)
Coping techniques during chewing the khat
These are also measures taken during the chewing process which is believed to minimize or moderate the effects of khat. It was reported that khat makes someone feeling high to the extent of uncontrollable and causing a kind of confession, constipation, drying of the mouth. It also retains urine and causes kidney problems. Thus, participants dink too much water to increase urination and minimize drying of mouth and intestinal constipation. A drink called ‘Meqni' which is a mix of milk and tea is also believed to return to the normal mood and have a calming effect from the effect of high feeling after khat use. To illustrate this, one of the interviewees said:
‘Ahh… Meqni is a drink which she [mentioned sales women name] prepares by mixing tea with milk and it has a calming effect which makes you moderately calm when you become at a state of emotionally heightened ‘ደስ የሚል ምርቃና ወይም ቂምሃ ያደርጋል’ And it is just making you neither have an elevated mood nor to feel depressed after chewing, and it helps to be cool down and return to normal mood.’ (IDM-06, age 24)
Another respondent also reported:
‘I have never experienced any problem until now because I use a large amount of water when I chew. So, I have never sought help.’ (FGM-14, age 20)
Coping techniques after chewing the khat
These are also perceived measures that are believed to reduce or control effects that occur after the consumption of khat. As users reported above, khat users also complain of sleep problems and experience of low mood after chewing or at night. Some respondents argue drinking cold milk at night helped make oneself calm and to get have sleep and also soften intestine. Besides, taking alcohol after chewing also perceived as having a refreshing effect and as a coping measure to curb the low mood. One of the participants thought ‘‘I drink cold milk at night these help me to soften my intestine.'' (FGM-14, age 20). Another respondent also confirmed this by saying:
‘Khat does not cause any harm to me because I drank milk most of the time at night and that was helping me because I did not feel comfortable when I didn't drink at all.’ (FGM03, age 23)
A nineteen years old female participant also describes:
‘There is something called "Chebsi" which is drinking alcohol after chewing to be calm and to get sleep otherwise you become tired in the morning even you may not wake-up easily.’ (IDF-04, age 19)
Despite the aforementioned perceived coping measures, participants also took provisional measures regards to effects they had experienced. For example, measures for effects regard to gastric pain were; quitting chewing until recover, taking medicines from the pharmacy, and for effects regards to expenses; allocating money for daily expenses. A respondent explains this:
‘There was even a time that I worry about khat rather than eating food. Since I start chewing until three or four years, I couldn't resist it. But now I try to figure out through updating myself with a plan, for example, I allocate money for my lunch and to khat and live my life the way I am today. (IDM-06, age 24)
On the contrary, some respondents mentioned they cannot resist the effects of khat and struggling with its effect.