title: Khat dependence syndrome: a cross sectional preliminary evaluation amongst UK-resident Yemeni khat chewers.
abstract: BACKGROUND
  Khat is a natural psychostimulant that has pharmacological effects similar to that of amphetamine. The behaviour of khat chewing is embedded within a cultural context. Meanwhile khat chewing is associated with psychological and physiologically burden, as a 'dependence producing' substance.
  
  
  OBJECTIVE
  To assess the applicability of the construct of substance dependence syndrome (DSM-IV, 1994) to khat chewing and to examine psychosocial and behavioural correlates of this syndrome including tobacco use.
  
  
  METHODS
  A sample of 204 khat chewers was recruited during random visits to khat sale outlets. A face to face interview that assessed socio-demographic, psychosocial dependence, substance dependence syndrome and behavioural characteristics was conducted. Descriptive, exploratory psychometric and multivariate analyses were employed.
  
  
  RESULTS
  Approximately a third (31%) of khat chewers reported symptoms consistent with dependence syndrome including increased khat chewing (13%) and cessation attempts (19%) while 17% reported withdrawal symptoms including depression (61%), increase in appetite (74%) and interrupted sleep (58%). Thirty-eight percent reported continued khat chewing despite impacts on their health. Psychometric assessment of the DSM-IV criteria for khat chewing dependence identified two factors; factor 1 consisted of bio-behavioural items and factor 2 withdrawal items, accounting for 67% of the variance and Cronbach's alpha coefficient at 0.78. In multivariate logistic regression modelling, there was an association between intensity of psychological khat dependence (SDS-Khat) and nicotine dependence with the likelihood of exhibiting khat chewing dependence syndrome (p=0.0005, OR=1.51, 95%CI=1.33-1.71; p=0.043, OR=2.87, 95%CI=1.03-7.98, respectively).
  
  
  CONCLUSIONS
  The substance dependence syndrome criteria are applicable to khat chewing and associated with increased intensity of nicotine and psychological khat dependence. The applicability of khat dependence syndrome and exploration of its dimensions and associated factors should be extended in future research. Concurrent validation of these findings using specific objective measures for self-report khat chewing is also recommended.
authors: Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Institute of Dentistry, 4 Newark Street, London E1 2AT, UK. s.kassim@qmul.ac.uk
authors: Saba
authors: S
authors: Kassim
authors: Ray
authors: R
authors: Croucher
authors: Mustafa
authors: M
authors: al'Absi
mesh_terms: D000328:Adult; D029754:Catha / Q000009:adverse effects*; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008409:Mastication; D011594:Psychometrics; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000208:ethnology* / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D015006:Yemen / Q000208:ethnology
chemical_list: D000697:Central Nervous System Stimulants