Mihretu Awoke, Teferra Solomon, Fekadu Abebaw
Department of Clinical Psychology, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Subst Abuse Treat Prev Policy. 2017 Mar 21;12(1):17. doi: 10.1186/s13011-017-0100-y.
Khat is a psycho-stimulant herb, which has been in use in traditional societies in East Africa and the Middle East over many centuries. Although khat is reported to cause various health problems, what constitutes problematic khat use has never been systematically investigated. This study explored the acceptable and problematic uses of khat from the perspective of users.
The study used a mixed methods design (exploratory sequential) in which qualitative (emic) data were collected to develop a framework to define problematic khat use. The qualitative data were gathered through in-depth interviews (N = 13) and focus group discussions (N = 34). By supplementing the emic experiences considered to constitute problematic khat use with an etic definition, DSM-5 criteria for stimulant related disorders, a structured questionnaire was developed. Subsequently a cross-sectional evaluation of 102 respondents was carried out. Respondents both for qualitative and quantitative study were selected through purposive sampling and snowballing methods. Qualitative data were transcribed and subjected to thematic analysis whereas quantitative data were analyzed using descriptive and nonparametric statistics.
Khat use was acceptable socio-culturally and for functional purposes. However, even in these acceptable contexts there was a restriction to the amount, frequency and type of khat used, and in relation to the experience of the individual using khat and other personal characteristics. More specifically, khat use was considered problematic if there was: 1) Impairment (in social and occupational functioning); 2) loss of control in the use of khat; and 3) withdrawal symptoms when not using khat. Among the participants who use khat (n = 102), 45.1% (n = 46) used khat on a daily basis. The commonest indicators of problematic khat use endorsed by the khat users were loss of control over chewing (73.5%), continuing use of khat despite harm (72.5%) and efforts to avoid withdrawal from khat (61.8%).
Despite reported religious, sociocultural and functional benefits to the use of khat, those with defined problematic khat use have impaired mental health, and social and occupational performance. Comparison of these respondent defined indicators of problem behavior matched almost completely to the DSM-5 (etic-defined) understanding of problematic stimulant use. Although the findings have relevant clinical, research and policy implications, the study focused on users purposively identified. Future larger scale definitive studies are required to make concrete policy recommendations.
巧茶是一种精神兴奋草药，在东非和中东的传统社会中已使用了数百年。尽管据报道巧茶会引发各种健康问题，但何为有问题的巧茶使用从未得到系统研究。本研究从使用者的角度探讨了巧茶的可接受使用和有问题的使用情况。
本研究采用混合方法设计（探索性序列设计），收集定性（主位）数据以建立一个界定有问题的巧茶使用的框架。定性数据通过深入访谈（N = 13）和焦点小组讨论（N = 34）收集。通过用刺激物相关障碍的DSM-5标准这一客位定义补充被认为构成有问题的巧茶使用的主位体验，编制了一份结构化问卷。随后对102名受访者进行了横断面评估。定性和定量研究的受访者均通过目的抽样和滚雪球法选取。定性数据进行转录并进行主题分析，而定量数据则使用描述性和非参数统计进行分析。
巧茶的使用在社会文化和功能方面是可接受的。然而，即使在这些可接受的情况下，巧茶的使用量、频率和类型也存在限制，并且与巧茶使用者的个人体验和其他个人特征有关。更具体地说，如果存在以下情况，巧茶的使用被认为是有问题的：1）损害（社会和职业功能方面）；2）巧茶使用失去控制；3）不使用巧茶时出现戒断症状。在使用巧茶的参与者（n = 102）中，45.1%（n = 46）每天使用巧茶。巧茶使用者认可的有问题的巧茶使用的最常见指标是咀嚼失去控制（73.5%）、尽管有害仍继续使用巧茶（72.5%）以及努力避免停止使用巧茶（61.8%）。
尽管据报道巧茶的使用有宗教、社会文化和功能方面的益处，但那些有明确的有问题的巧茶使用的人心理健康、社会和职业表现受损。这些受访者定义的问题行为指标与DSM-5（客位定义）对有问题的刺激物使用的理解几乎完全匹配。尽管这些发现有相关的临床、研究和政策意义，但该研究聚焦于有目的地确定的使用者。未来需要进行更大规模的确定性研究以提出具体的政策建议。
