Is khat use disorder a valid diagnostic entity?. (2nd June 2016)

• Record Type: Journal Article
• Authors: Duresso, Samson W.; Matthews, Allison J.; Ferguson, Stuart G.; Bruno, Raimondo
• Is Part Of: Addiction. Volume 111:Number 9(2016)
• Page Start: 1666
• Page End: 1676
• Publication Date: 2016-06-02
• Subjects: Catha -- central nervous system stimulants -- DSM‐5 -- DSM‐IV -- khat -- khat dependence -- khat use disorder -- stimulant use disorder -- substance –related disorders; Alcoholism -- Periodicals; Drug addiction -- Periodicals; 616.86
• DOI: 10.1111/add.13421
• Languages: English
• ISSNs: 0965-2140

Abstract

Abstract: Aims: This study aimed to validate the presence of a khat use disorder syndrome using DSM‐5 criteria and to examine its relationship with increased experience of harms. Design: Cross‐sectional, purposive sample of current khat‐chewers, recruited from khat markets and cafes. Setting: Participants were recruited from the general community and from Adama Science and Technology University in Ethiopia. Participants: A total of 400 current khat consumers aged 16 and above were recruited between September 2014 and January 2015 Measures: Survey comprising current clinical symptoms (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule‐IV), and validated measures of health, psychological distress, quality of life and academic functioning. Findings: A third [35.5% 95% confidence interval (CI) = 31.0–40.3] of respondents reported daily khat use and a quarter (25.4% 95% CI = 21.4–30.0) using three times or more per week. Using DSM‐5 criteria, 10.5% (95% CI = 7.9–13.9) were categorized as experiencing mild, 8.8% (95% CI = 6.4–12.0) moderate and 54.5% (95% CI = 49.6–59.3) severe khat use disorder. Confirmatory factor analysis demonstrated a good fit of symptoms to a single underlying construct, consistent with other substance use disorders. Individuals categorized as experiencing khat use disorder demonstrated significantly greater frequency [odds ratio (OR) = 45.29; 95% CI = 10.97–19.01) and quantity of khat use (OR = 2.35; 95% CI = 1.29–4.29). They also demonstrated increased financial problems associated with use, greater problems with academic functioning and higher rates of self‐reported mental health problems, higher psychological distress and poorer quality of life. Treatment access was poor, with only one‐third (32.9%) of individuals with khat use disorder reporting life‐time access, near‐exclusively related to help‐seeking from friends and relatives. Conclusion: The construct of a substance use disorder syndrome for khat using DSM‐5 criteria appears valid and performs in a manner consistent with other substances of dependence. Individuals with khat use disorder experience substantial problems in association with khat use. Despite this, there are low levels of help‐seeking for these problems.