Abstract
BackgroundSubstance use disorders along with neuropsychiatric disorders contributed about 14% of the global burden of disease. Harmful alcohol use, is a known contributor for many harms (accidents, suicide, violence, and complication of other psychiatric and medical disorders). In the Western countries, alcohol and nicotine are gateway drugs to cannabis use, and cannabis use is a risk factor for other illicit drugs such as cocaine and heroin. Khat use is another psychoactive substance which is common in East African and Arabian Peninsula. But there is a knowledge gap regarding the position of khat use or problematic khat use in sequential progression of different psychoactive substances. Therefore, we aimed to understand and investigate the relationship of problematic khat use and other psychoactive substances in Ethiopia.MethodsExploratory mixed methods study was employed. Quantitative cross sectional survey was done among 102 khat users, and 4 focus group discussions and 11 in-depth interviews were conducted to understand the pathways between khat use and other psychoactive substances use in 2014. Non random sampling (purposive and snowballing) was employed for both quantitative and qualitative studies. Khat users from khat cafeterias, shops, and from other open markets of khat in Addis Ababa were invited to participate.ResultCurrently significant majorities of khat users (86.3%) used at least one other psychoactive substance after they started khat use. The prevalence of harmful drinking was 53.9% among khat users. Problematic khat use was a significant predictor of harmful drinking (p < 0.05). About one from ten respondents engaged to risky sexual behavior pushed by the effect of khat after chewing.ConclusionThe proportion of psychoactive substances use especially harmful drinking among khat users was observed higher compared to other cross sectional surveys conducted among general population. In Ethiopia, intervention and policy on harmful alcohol use could consider problematic khat use as one possible risky factor. A rigorous methodology which could test gateway hypothesis of problematic psychoactive substances use could be warranted.
Highlights
Substance use disorders along with neuropsychiatric disorders contributed about 14% of the global burden of disease
The proportion of psychoactive substances use especially harmful drinking among khat users was observed higher compared to other cross sectional surveys conducted among general population
In Ethiopia, intervention and policy on harmful alcohol use could consider problematic khat use as one possible risky factor
Summary
Substance use disorders along with neuropsychiatric disorders contributed about 14% of the global burden of disease. In the Western countries, alcohol and nicotine are gateway drugs to cannabis use, and cannabis use is a risk factor for other illicit drugs such as cocaine and heroin Khat use is another psychoactive substance which is common in East African and Arabian Peninsula. Previous studies have documented a reliable pattern for initiating substance use, with many adolescents beginning with nicotine and/or alcohol and progressing to illicit drugs [2, 3] In another setting, regular or heavy cannabis use was associated with an increased risk of using other illicit drugs [4]. Regular or heavy cannabis use was associated with an increased risk of using other illicit drugs [4] Khat use is another psychoactive substance which is common in East Africa, Arabian Peninsula and immigrants living in the west from these countries [5, 6]. These studies indicated that Khat use was mainly associated with Muslim religion followers, males, alcohol drinkers and cigarette smokers
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