Definition and Validity of the Construct “Problematic Khat Use”: A Systematic Review

Abstract

Background: Problematic khat use, not khat use per se, is a public health and social concern for the public, researchers, and policy makers. However, the construct problematic khat use is not well-established and not fully recognized in the modern definition of substance use disorders including Diagnostic Statistic Manual (DSM-5) and international classification of diseases (ICD-10), although DSM-5 included it in the “stimulant use disorder” category. Existing scoping reviews have focused on khat use, which could not allow the differentiation of khat use from problematic khat use. Thus, the aim of this systematic review was to define and validate the construct problematic khat use. Methods: This systematic review was reported following the PRISMA guidelines. We searched all English language studies without publication date restriction from 5 databases; PubMed, EMBASE, psychINFO, SocINDEX, and Google scholar. All studies that defined, explored, evaluated, or measured the construct problematic khat use were included. Adapted data extraction tool and criteria for quality evaluation were employed. We presented the results in tables and thematic synthesis of the major findings. Result: Overall, 30 qualitative and cross-sectional design studies were included. Associated harms with khat use, an increased amount used, increased frequency of use, and withdrawal experiences were indicators of problematic khat use. Using khat on an average of 3 or more times per week and using other psychoactive substances during and after khat use were frequently used to define problematic khat use. The most frequently reported withdrawal symptoms were depressed mood, irritability, fatigue, lack of motivation, increased sleep, and appetite. The existing measures (severity of dependence scale and DSM-5) of problematic khat use had psychometrically acceptable properties in terms of construct, criterion, and convergent validity, but they are poor in terms of other domains of validity including content, conceptual, and semantic validity. Conclusion: Problematic khat use constitutes, but is not limited to, harms, increased use over time, and frequent engagement in other psychoactive substances misuse. Khat use is different from problematic khat use since it is occasional and used for prayer, social, and functional reasons. Strong empirical studies that could establish thresholds for patterns of problematic khat use and a culturally suitable problematic khat use measures that follows a bottom-up approach of scale development are warranted.

Cathinone Use Disorder in the Context of Slam Practice: New Pharmacological and Clinical Challenges

“…In a 2019 systematic review by Mihretu et al. ( 46 ), the prevalence of problematic khat use ranged from 20.6% to 80.7% in khat-chewing communities in Ethiopia, Saudi Arabia, and Somalia. Thus, it is clear that khat, which contains a derivative of amphetamine, can induce substance use disorder and that by their chemical proximity, synthetic cathinones are potentially capable of inducing substance use disorder.…”

“…The systematic review by Mihretu et al. highlighted the psychological dependence that complicates the use of khat ( 46 ). The results regarding stimulant use disorder are more nuanced.…”

“…For example, in the article by Duresso et al (45), the criterion "continuation use despite physical/psychological problems" was the most prevalent; "tolerance" and "withdrawal" were among the least represented. The systematic review by Mihretu et al highlighted the psychological dependence that complicates the use of khat (46). The results regarding stimulant use disorder are more nuanced.…”

Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study

“…Nevertheless, only few studies on problematic khat use have been conducted. 32 The inconclusive reports on the different harms of using khat could be due to the poor definition of problematic khat use. 32 The Diagnostic Statistical Manual (DSM-5) definition of stimulant use disorders 33 could have more important clinical utility (for severe cases) than screening individuals with problematic khat use at an earlier stage.…”

“…32 The inconclusive reports on the different harms of using khat could be due to the poor definition of problematic khat use. 32 The Diagnostic Statistical Manual (DSM-5) definition of stimulant use disorders 33 could have more important clinical utility (for severe cases) than screening individuals with problematic khat use at an earlier stage. Lack of screening tools for problematic khat use, especially among non-clinical cases, could hamper efforts to curb the problems, including early identification and effective management of positive cases.…”