Statement of the problem
Khat is a natural cathadulis stimulant cultivated in the Republic of Yemen and most countries in eastern Africa.(1) It is a plant with a large green shrub that grows at high altitudes in areas ranging from eastern Africa to the Arabian Peninsula between 1,500-2,000 meters above sea level. The number of people chewing Khat globally is estimated to range from 5 to 10 million, most of whom are in the Horn of Africa and the Arabian Peninsula, especially in Ethiopia, Somalia, and Yemen(2). Reports indicating that 80– 90% of East African males use khat daily and 10–60% of East African females use khat daily (3, 4). Khat is also consumed by immigrants from these regions who reside in western countries, including the United Kingdom (UK) and the United States of America (5).
Cathinone, an alkaloid in Khat, is considered responsible for the effects of chewing the leaves of the plant, such as excitement, loss of appetite and euphoria (6). On average, Fresh Khat contains 36 mg of cathinone, 120 mg of cathine, and 8 mg of nor ephedrine per 100 g of leaves (7). After Khat chewing, the Cathinone plasma level reached a height of 1.5–3.5 hours (8).
Khat has a stimulant effect on the body (9, 10). This stimulates both the peripheral and vital nervous system, causing, for instance, insomnia, alertness, anorexia, and increased respiration, body temperature, blood, and heart rate (10). Despite its popularity, there are sufficient evidences of adverse effects on physical and mental health as well as social well-being. It causes serious adverse neurological, psychiatric, cardiovascular, dental, gastrointestinal and genitourinary health problems (11–13). Following a khat session, the user may experience depressed mood, irritability, anorexia and difficulty falling to sleep (14)
Functional mood disturbances (anxiety and depression) have also been reported during khat sessions, but these are temporary and may disappear the next day (10). Some khat chewers experience, tension, restlessness, hypnagogic hallucination, hypomania and aggressive behavior or psychosis (15).
Chronic consumption can lead to impairment in mental health, possibly contributing to personality disorders and mental deterioration (16, 17). It leads to elevated blood pressure, increased in heart rate and increased incidence of acute myocardial infarction (18). Gastro intestinal hazard include constipation, stomatitis, esophagitis and gastritis (19).
A significant association between habits of khat chewing and the development of heamorrhoidal disease was reported (20). Evidence indicates that long-term or excessive khat use is a risk factor for progression of ongoing mental health problems (4, 12, 13). It has been also linked with the use of other drugs and behaviors such as smoking, alcohol use and risky sexual behavior (21, 22)
Even though chewers in general and students in particular use khat to increase their concentration during studying, it was reported that students who use khat have less academic performance than non-users and chewing khat also encourage school absenteeism (10, 23).
Khat was listed by the World Health Organization (WHO) as a substance of abuse that can lead to mild to moderate psychological dependency, but to a lesser extent than nicotine and alcohol (24). And the WHO does not consider Khat to be as dangerously addictive as cocaine (1)
Excessive and prolonged khat use could have the potential to induce psychological dependence with a dominant feature similar to dependence on amphetamine-type stimulants(25). The potential to induce psychological dependence is confirmed by a number of recent studies, using a version of the Severity of Dependence Scale (SDS) that has been adapted and validated for the study of khat dependence (26, 27). It has been shown that khat chewers scoring high on this instrument show more khat-related behaviors and have higher khat alkaloid levels in their saliva (28). About 39% of a sample of Yemeni khat users living in the UK scored at a level comparable with a clinical population with severe heroin dependence in need of treatment (29).
Little information is available on the prevalence of khat dependence as defined by the International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM). Recently, a study showed the applicability of the dependence syndrome as defined by DSM-IV (30). 31% of a group of 204 khat users of Yemeni origin living in the UK fulfilled the DSM-IV criteria for dependence (30). while 84% of 25 chronic psychotic patients in Somalia and 100% among 33 khat-using male Somali refugees in Nairobi (31) fulfilled the DSM-IV criteria for dependence.
Older age, male gender, Muslim faith, having friends who chewed khat and the availability of someone with similar family habits were found to be independent predictors of chewing, according to the study done in Harar town (58). Depression, anxiety and cigarrete smoking are show significant association with psychological khat dependency among different population group.(26, 45, 59). There is also significant association between psychological khat dependency and duration of chewing khat in each session, days chewing khat per week and amount of khat chewed in each session according to the study conducted among UK residents Yemeni khat chewers (26).
By other hand psychological dependency and gender show significant difference according study conducted in Ethiopian using the WHO’s Composite International Diagnostic Interview, among representative sample from a traditional khat-producing area, in this study the life time prevalence of khat dependency among male and female were found 5% and 1.3% respectively.(32)
Even if khat use has become a common problem among university students in Ethiopia, only scant information is available about the magnitude of psychological khatdependency and factors contributing for its use in this segment of the population. Furthermore, the effect of khat use is not wellexplored. Therefore, the aim of this study was to assess the magnitude of psychological khat dependency and associated factors among Mettu university students.