Crazy as a khat?

Researchers investigating the evidence for a potential causal link between khat use and mental illness – in the first ever systematic review of the topic – have called for improved research on the stimulant plant, and its possible association with psychiatric disorders.

In light of ongoing international concern about a contributory association between use of khat and ill mental health, Dr Nasir Warfa – lecturer in Transcultural Psychiatry at Queen Mary, University of London – has reviewed clinical case reports, alongside qualitative and quantitative articles on khat use and mental illness, dating back over 50 years. The work was undertaken in partnership with colleagues at the Institute of Psychiatry, University College London, and the University of Kent.

The findings, which appear online in the social science journal, Social Science and Medicine, show that whilst khat use appears to exacerbate existing psychological problems, there is not currently, any clear evidence which indicates that khat use is a catalyst for the development of mental illness.

Commonly used by around 10 million people in east Africa and countries in the Arabian peninsula, chewing khat for its stimulant properties has also become popular in the UK among immigrants of the Somali, Yemeni and Ethiopian communities. Whilst it is reported to have cultural functions, it is also increasingly reported to be associated with social and medical problems including anti-social behaviour, unemployment, psychoses, depression, and self-neglect.

Crucially, there is also a link between poverty and widespread misuse of khat. In east Africa, 60 per cent of the population live below the poverty line, yet sizeable numbers of khat users borrow money to obtain the drug, exacerbating poverty levels and eroding the quality of life of khat users and their communities. It is in this context, that researchers are planning to undertake a new study to examine khat as a cause of poverty and a failure of regeneration and economic prosperity.

Whilst anecdotal evidence does point towards there being a consequence of mental illness via excessive use of khat, particularly where there is a pre-existing mental illness or vulnerability to psychological distress, Dr Warfa and his team argue that “there are many other alternative hypotheses to a causal relationship between khat use and mental illness including the use of khat for self-medication”. The researchers suggest that only by improving the quality of future research, and integrating social, medical and pharmacological studies, can a more incisive understanding of the psychological and social impact of khat on individuals and communities be gained.

Further, the researchers recommend that any future policy developments in the UK should feature health and social care which is culturally and socially appropriate. Dr Axel Klein, lecturer in the Study of Addictive Behaviour, University of Kent, also warns that potential legislators should consider the repercussions of criminalising large sections of the community – such as the evolution of new organised crime groups based on khat trafficking, and the perverse consequence of increased risk behaviour among khat users.

Dr Warfa said: “We need to revisit existing theories of addiction and substance use to include a new model to understand consumption of khat not only among migrant communities in the West but also in conflict and post conflict settings. This will take account of the cultural context, and the socio-economic and psychological implications of khat use. This would allow the formulation of appropriate and contextualised social policy and harm reduction strategies, particularly in the context of maximising impacts from campaigns against global poverty”.

Queen Mary University of London