Khat Addiction Treatment

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ARTICLE OVERVIEW: If you’re having problems with Khat, this article will explain what you can do about it. You’ll learn to recognize the signs of a problem. Plus, you’ll know what to expect from a reputable treatment clinic. More here, with a section at the end for questions

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ESTIMATED READING TIME: 15-20 minutes.

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TABLE OF CONTENTS:

• Definitions
• Brain Effects
• Understanding Addiction
• Why Does Addiction Occur?
• Signs of a Problem
• Demographics
• Short-Term Effects
• Long-Term Effects
• Withdrawal
• Safely Breaking Free
• Main Options
• What Happens In Rehab
• Detox
• Do I Need Detox?
• Medications
• Financing
• Dual Diagnosis
• How To Help Someone
• Aftercare

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The Definitions

Khat is a plant that grows naturally in East Africa and on the Arabian Peninsula, mainly in Yemen, Kenya, and Ethiopia. In the United States, the use of Khat occurs most often in large cities with immigrant populations that come from Africa (particularly Somalia and Ethiopia) and the Middle East. Khat is actually an evergreen shrub, which is cultivated as a bush or small tree. The leaves have an aromatic odor. The taste is astringent and slightly sweet. The plant is seedless and hardy, growing in a variety of climates and soils. Many different compounds are found in khat including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins and minerals.

Many people believe that Khat is an herb that can be safely used to encourage concentration. Others believe that it is a stimulant drug, similar to amphetamine but slightly less potent. Also, this plant is used to make the drug known as “bath salts”. In fact, the leaves of khat are chewed by the people for its stimulant action. Its young buds and tender leaves are chewed to attain a state of euphoria and stimulation.

But what can the brain effects of Khat trigger addiction?

Brain Effects

According to the DEA, ther is no accepted medical use of khat in the U.S. In fact, cathinone and cathine are placed in Schedules I and IV of the Controlled Substances Act. So, how do these naturally occurring compound act in the brain?

Khat contains two alkaloids which act as stimulants: cathinone and cathine.

1. Cathinone is believed to have the greater effect on Khat users and is classified by the Drug Enforcement Administration (DEA) as a Schedule I drug, meaning that it has an extremely high potential for abuse, physical dependence, and addiction, and it has no accepted medical value.
2. Cathine, on the other hand, is categorized as a Schedule IV drug, meaning that it has a low potential for abuse, and is currently accepted for use in medical treatment.

The phenylalkylamines and cathedulins found in khat are major alkaloids which are structurally related to amphetamine. The primary effects of khat include those on the gastro-intestinal system and on the nervous system. Constipation, urine retention and acute cardiovascular effects may be regarded as autonomic (peripheral) nervous system effects. Khat also affect the nervous symptom to trigger:

• A sense of well-being, or euphoria.
• Increased alertness.
• Psychiatric symptoms.
• The hallmark effects of dependence and tolerance.

Khat is abused for its stimulant and euphoric effects. Most often, the fresh leaves and shoots of the khat shrub are chewed, and kept in the cheek until all the juices are extracted. To counter the bitter taste of the plant, people tend to drink copious amounts of water or sweet soda.

Signs of using khat usually begin to subside about 90 minutes after the leaves and stems are chewed or drank. The high can linger for three to 24 hours, depending on the potency of the khat and intensity of the addiction. Once the high subsides, the user crashes. This results in feelings of anxiety, depression, extreme fatigue, suicidal thoughts and heart arrhythmia. Toxic effects of khat include increased blood pressure, tachycardia, insomnia, anorexia, constipation, general malaise, irritability, migraine and impaired sexual potency in men.

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When you use khat, you experience the short-term effects of the drug. These effects include a mild euphoria and a sense of calmness as your use progresses.

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Understanding Addiction

It´s important to understand what Khat addiction is. People who are addicted to Khat often do not realize that they are addicted. They may think that the drug is actually quite safe, and so the risk of addiction does not worry them.

The euphoric feeling you are experiencing are what make you begin to crave the drug. This is because of the changes in your brain chemistry that occur as you use. These changes can cause you to feel like yourself only when you are using Khat. The result is cravings and withdrawal symptoms afterwards.

It’s important to understand the difference between addiction and abuse when it comes to Khat. Someone may be abusing Khat, but that person may not have formed an addiction to it. Khat abuse involves using the drug sporadically, and not on a regular basis. The individual may enjoy the effects of it, but not feel a need to use it. When use has stopped, there are no withdrawal effects at all. If any of these apply to you, you are probably participating in Khat abuse.

That may put your mind at ease about your Khat use. However, please proceed with caution. Although you might not be addicted to Khat right now, that can quickly change. The more you continue to use Khat, the more at risk you are for becoming addicted to it.

Why Does Khat Addiction Occur?

Khat addiction typically occurs when users take the stimulant chronically for a prolonged period of time by chewing the green Khat leaves (similarly to how tobacco is chewed), smoking the drug, making it into tea, or sprinkling it on food. Those who abuse Khat often take it:

• As a weight loss agent that suppresses the appetite.
• Recreationally, to produce a feeling of calm often described as being ‘blissed out’.
• To feel more happy and talkative.
• To improve academic performance (high school or college students).
• To stay awake and improve alertness.

The Khat “high” can linger anywhere from 3 and up to 24 hours, depending on the potency of the Khat and intensity of your addiction. However, once the high subsides, you experience a “crash” which results in feelings of anxiety, depression, extreme fatigue, suicidal thoughts and heart arrhythmia. These feelings only drive a person to take the drug again and again…leading to a vicious cycle of suffering from the effects of Khat and needing the drug to make the effects go away.

Signs of a Problem

If you believe that your or a loved one’s “harmless” recreational use has turned into a dangerous and progressing habit, it may be time to consider treatment. If you are looking for signs of Khat addiction, please note that these will be similar to those of meth and cocaine. The main signs of addiction include:

1. Being unable to quit on your own.
2. Loss of control of drug dosing or frequency of use.
3. Using khat despite negative consquences to home, health, or social life.

The drug contains cathinone and cathine, two stimulant chemicals that helped classify the drug as illegal for use in the U.S. The stimulants in khat are also the culprits behind that rush that users feel when the drug is absorbed into the bloodstream. When that occurs, the addict immediately feels the following signs:

• Aggression.
• Alertness.
• Energy increase.
• Fever.
• Insomnia.
• Loss of appetite.
• Paranoia.

Who Is At Risk /Demographics

An estimated 5 to 10 million people globally use khat on a daily basis. The traditional form of khat chewing in Yemen involves only male users; khat chewing by females is less formal and less frequent. Researchers estimate about 70–80% of Yemenis between 16 and 50 years old chew khat, at least on occasion. Approximately 60-90% of male and 35% of female Yemenis chew khat daily.

Furthermore, research suggests that about 20 million people all around the worls are rgular of khat. Although khat use began in the Ethiopian and Arabian regions, in the past few decades use has extended to other parts of the world, including Europe and the United States. One of the reasons for widespread use of khat is that scientists have created synthetic forms of the drug, which has made access to khat easier in recent years. Many of the khat users in western countries are immigrants from the Middle East or Eastern Africa.

Khat has been brought by to the U.S. immigrants from East Africa and the Middle East who have settled in communities around Europe and North America. Khat is an illegal substance in most of Europe and North America, often included in the same drug category as cocaine. Khat use is still highly prevalent in the countries mentioned, and in African and Yemeni emigrant groups. As with alcohol use in many countries, khat use can be considered as a lifestyle in some specific countries, covering the spectrum from nonproblematic use to problematic use and dependence. Khat dependence is associated with high morbidity and societal and economical costs.

Short-Term Effects

The effects of using khat are similar to those of other amphetamines. The acute (short-term) effects subside after 90 minutes to 3 hours, but can last 24 hours. Chewing khat can cause:

• A state of euphoria and elation.
• Aggressiveness.
• Anxiety.
• Feelings of increased mental alertness and arousal.
• Feelings of well-being.
• Increased blood pressure, breathing rate and heart rate.
• Lack of concentration, loss of energy and insomnia.
• Manic behavior, paranoia or psychosis.
• Suppression of appetite.

Despite being viewed as a “safe” and “natural” substance, Khat can deliver very real physical and psychological dangers. The effects of Khat are similar to those of methamphetamine and cocaine. Key health effects and risks of Khat include:

• Agitation.
• Appetite suppression.
• Bodily shaking or tremors.
• Disrupted sleep and periods of insomnia.
• Nervous tendencies.
• Risk of significant liver toxicity from excessive use.
• Severe restlessness.
• Talkativeness.
• Worsening of pre-existing mental health problems.

Long-Term Effects

Dangerous side effects associated with heavy or long-term use of khat. Despite generally being considered a mild stimulant with moderate physical addiction, khat is proven to be psychologically addictive as well.

Long-term use of Khat can lead to malnutrition, depression, gastro-intestinal (GI) disorders, cardiovascular problems, hemorrhoids, paranoia, nightmares, hyperactivity, hallucinations, oral cancer, inflammation of the oral tissues (similar to “meth-mouth”), and impaired sexual function in males. Others effects of khat over the long-term include:

• Tooth decay and periodontal disease.
• Gastrointestinal disorders: ulcers, stomach inflammation.
• Cardiovascular disorders: irregular heartbeat, myocardial infarction.
• Chewing khat leaves may worsen pre-existing psychiatric conditions.
• Khat abuse causes serious liver damage.
• Regular use may lead to insomnia, anorexia, anxiety and irritability.

Withdrawal

Similar to other cases of stimulant withdrawal, khat withdrawal symptoms are like a prolonged “crash” experienced after the extreme high of the stimulant. People who develop physical dependence on Khat may experience unpleasant withdrawal symptoms when they try to lower doses or quit cold turkey, such as:

• Anxiety.
• Depression.
• Extremely vivid nightmares.
• Fatigue.
• Intense lack of energy.
• Irritation and psychosis.
• Loss of interest in any activity.
• Suicidal thoughts.
• Trembling and shaking.

Fortunately, theseal symptoms can be managed or even avoided by undergoing detox in a treatment facility. Treatment programs are designed to address withdrawal by addressing symptoms as they occur.

Left untreated, feelings associated with Khat withdrawal can lead to thoughts of suicide. In fact, suicide is the most common cause of death associated with excessive use. This is why it is so important to seek medical help during detox, withdrawal, and the acute period as you stop taking Khat.

Safely Breaking Free From Khat

How can you safely quit Khat? Addiction treatment is most safe when you seek help from medical professionals.
Before you select a particular treatment center, experts can help you identify and diagnose your particular drug problem. You see, everyone’s needs are different. So, before you decide on a rehab program, be sure to consider these key factors:

• Co-occuring mental health conditions.
• The amount of recovery support from your family and community.
• The severity of your addiction.
• Your individual preferences and goals.
• Your medical and mental health history.

In short, the best program for you is the one that feels comfortable, emotionally safe, and offers the amenities you need for optimal benefit while you are there. There is no one-size-fits-all method to addiction treatment, so care must be tailored to the specific needs of each person in treatment.

Main Options

Reputable and evidence-based treatment programs offer a wide variety of treatment settings, program duration, therapies and approaches. Here’s we will focus on the three main treatment options that can get you started. Let’s review the basics:

TREATMENT OPTION 1: Inpatient vs. Outpatient Settings. Addiction rehab clinics provide either inpatient or outpatient treatment.

Inpatient (or residential) rehab provides a safe, secure, drug and distraction-free environment with 24-7 supervision. During rehab, you can learn how to manage cravings and cope with life without getting high. During residential rehab, counselors combine treatment modalities with lifestyle interventions to address the underlying causes of your addiction, and to also give you a firm base of skills that will keep you sober when you graduate from the program.

Outpatient rehab is scheduled around work or school hours. This allows you to continue your everyday responsibilities while getting treatment for several hours, a few days per week. Although these programs may provide the level of flexibility that you need, their effectiveness can be limited, especially if you require medical and psychological recovery services. An additional strain is that living at home keeps you close to people who use Khat and situations where drugs are present.

TREATMENT OPTION 2: Program Duration

Inpatient rehab programs can last for 30, 60, 90 days or more (when needed). Likewise, outpatient rehabs recommend treatment for 3 to 4 months or more. In fact, successful treatment can take a commitment of 1-2 years, with a combination of BOTH inpatient and outpatient rehab.Although the required minimum duration of an inpatient rehab is 30 days. Higher success rates for most drug addiction are seen with 60 and 90 day programs, which allow more time for physical and psychological stabilization, therapy, and education. After 60 to 90 days of rehab, you can re-enter the world with a renewed sense of recovery and focus.

TREATMENT OPTION 3: Therapy

Psychotherapy and behavioral therapy are commonly called ‘the meat and bones’ of addiction treatment programs. In fact, addiction programs usually offer a combination of therapies for the duration of your rehab stay. Therapy approaches aim to pinpoint and resolve the core reasons that led to drug abuse and subsequent addiction. During this stage of treatment, behavioral, emotional and psychological therapies help you work on behavioral conditioning and prepare you to live a sober life. They may include:

• Cognitive Behavioral Therapy (CBT).
• Family therapy.
• Educational sessions.
• Group therapy.
• Holistic therapy.
• Nutritional counseling.
• Support group facilitation.
• Wellness activities.

In addition, as part of therapy, treatment professionals will assess and diagnose any co-occurring mental health conditions that may be contributing to the addiction issue. Then simultaneous treatment for all co-occurring disorders, also called Dual Diagnosis Treatment, is provided.

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What Happens in Rehab?

Rehab is about addressing cravings for the drug and learning to cope with life getting high. Khat users can accomplish this through group theray and individual talk therapy sessions with trained mental health workers. The goal also includes getting to the underlying issues behind the addiction in an effort to prevent the need for the drug in the future.

Some addicts use antidepressants and anti-anxiety medications after leaving a khat addiction treatment facility, as these drugs can help keep long-term depression at bay. Addiction treatment generally includes four (4) main stages of treatment.

STAGE ONE: Intake and Evaluation

When you enter rehab and get started, you will meet with a team of people who will be working with you. This can include a doctor, a psychologist, a case manager, and support staff. During intake, this team will take you through an interview, a physical exam, a medical history, and drug screening. They will thoroughly examine your case, including your medical history, your current health, and your past history of drug abuse. Rehab staff use this information to create your individual treatment plan.

STAGE TWO: Medical Detoxification

Medical detox helps you work through the withdrawal symptoms associated with stopping use of Khat. At a detox clinic, doctors and nurses monitor you and offer their support and assistance to improve your comfort, minimize any risks, and improve future recovery prognosis.

STAGE THREE: Therapy

In addition to providing a safe and drug-free environment in which to recover, Khat addiction treatment programs provide psychotherapy and behavioral therapies, which may be paired with pharmacological therapies. Therapy generally takes place on both an individual and group basis, addressing the core reasons that led to substance abuse and subsequent addiction.

STAGE FOUR: Continued Care and Relapse Prevention

Addiction treatment programs usually continue their help using periodic group therapy sessions and scheduled individual sessions after you leave their facilities. Aftercare and relapse prevention are a crucial step of the recovery process and significantly increase your chances of long-term rehab success.

Detox

Detox is more than just managing the symptoms of physical withdrawal. The strong psychological cravings that exist with the use of any stimulant type drug, such as khat, can increase the risk of relapse. Additionally, polysubstance abuse – such as the concurrent use of khat and alcohol – can complicate the withdrawal and detox process. A supervised detox program can ensure you have the safest, most comfortable detox process.

As the withdrawal symptoms are not generally life threatening, stimulant detox will usually be less medically complicated than detox from some other drugs, such as benzodiazepines or alcohol. However, certain psychological symptoms like depression may require medical intervention.

A supervised detox program provides emotional and behavioral support in a therapeutic environment that gives a much greater chance of success than trying to quit alone at home. Ideally, once detox is complete, you will continue on to a more robust addiction treatment program that includes therapy and counseling.

Do I Need Detox?

Khat is seen by many people as being only mildly addictive; however, studies have shown that prolonged use of khat may have a multitude of negative long-term effects. Indeed, it can be difficult for many people to stop without assistance, especially those whose culture is tightly tied to khat use. Cravings and mental health symptoms can also make stopping extremely difficult without the support of a formal program.

If khat use is negatively impacting your life and your health, you may need to help of a detox and treatment program to get off this substance for good.

Detox from a stimulant such as khat can be fairly simple and uncomplicated. However, research on withdrawal from stimulants indicates that many people quickly relapse and start using again after a period of abstinence. This quick relapse pattern indicates that although stopping the use of stimulants does not usually cause significant medical complications, the psychological dependence and cravings present significant challenges to many attempting to quit.

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Stopping khat without treatment assistance may be difficult for most people, and in some cases, such as those where depression and suicidal thoughts are a concern, medical supervision is strongly advised.

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Medications

If needed, you may be prescribed medications to treat specific withdrawal symptoms, such as antidepressants to stabilize mood or sleep aids to combat insomnia.

Financing

Let’s be real. Addiction treatment is not free.

We understand that you may feel like you cannot just put your life on hold and check into rehab when you have bills to pay. Addiction recovery takes time and money…but so does addiction. Just think about all of the effort, pain and suffering you are willing to go through to get and use Khat. So if you find yourself saying:

“I don’t have insurance to help me fund a rehab program.”
“I don’t have money to pay for treatment.”
“I don’t have the financial support to pay for a costly rehab stay.”

We know how you feel!

In fact, the lack of financial resources is the most commonly cited reason for avoiding rehab. However, we have a few ideas how you can make it into treatment!

Got insurance?

Call us to find out if your insurance provides coverage for addiction treatment.

No health insurance?

Healthcare.gov offers a state insurance marketplace where you can shop for affordable health insurance and compare prices. In addition, MedicAid has expanded its coverage to at least 5 million adults who qualify for addiction treatment. MediCare also covers the cost of substance abuse treatment.

No finances?

Look into a payment plan or sliding scale payment which allows you to pay for your treatment a little bit at a time. If you’re serious about getting better…invest in yourself. You can borrow from a savings account, 401(k), friends, or family. Health care credit cards allow you to finance health care costs at lower interest rates and make monthly payments.

Dual Diagnosis

When anyone struggling with a drug problem seeks help, rehabs should assess and diagnose any co-occurring mental health conditions that may be contributing to the addiction issue.

People tend to abuse Khat in order to self-medicate and cope with underlying mental health issues. On the other hand, Khat addiction may cause or aggravate a number of psychiatric disorders. The most common mental health disorders diagnosed with Khat addiction include:

• Anxiety.
• Antisocial disorder.
• ADHD.
• Conduct disorders.
• Major depression.
• Eating disorders.

When addiction is associated with a mental health problem, then it is a part of a dual diagnosis and an appropriate treatment program is required.

How to Help Someone

It can be tricky to know when a loved one needs some form of medical treatment or intervention for Khat abuse. If they are acting out of the ordinary, engage in impulsive and risky behavior, or you just get that gut feeling that something may be worng…you are probably right.

So, what can you do then?

#1 Call a helpline. 

Questions we typically ask include:

• Which substance/drug does the person abuse?
• What other drugs or alcohol do you think they’re using?
• How do they abuse Khat (orally, snorting, smoking)?
• How long do you suspect they have been using?
• How long they’ve been showing signs of addiction?
• How much can they afford to pay for treatment?
• Is insurance an option?
• Could you (and/or other close family members) help them out financially?
• Does the addicted individual suffer from any mental, behavioral, or co-occurring disorders?

#2 Stage an intervention. 

If a loved one is addicted to Khat, chances are they are dealing with a number of physical, emotional, and mental issues. If you are thinking of approaching a Khat addict, prepare yourself for ‘the talk’ and consider the possibility of staging an intervention with the help of a licensed interventionist, and ask for addiction professionals’ help.

#3 Use Community Reinforcement Approach and Family Training (CRAFT). 

CRAFT is designed to help family members intervene in such a way that they keep open communication and continue to care for their addicted loved one, while avoiding unhealthy behaviors like enabling and sacrificing their own self-care. The CRAFT approach can help motivate the individual to seek treatment. In fact, there is a multitude of empirical evidence that support the CRAFT-based strategy for staging a successful intervention as successful and effective for getting loved ones into treatment.

#4 Emphasize personal choice and control.

Trying to convince someone to get help through persuasion won’t help…it almost never does. As an alternative, open up the possibility of getting help from a professional counselor, a therapist, or a peer. Some examples of what you can say include:

“No one else can make you go to rehab. It is up to you to make this change. “
“I’m concerned about your Khat abuse. Tell me what I can do to help you.”
“I’m willing to support you during treatment, but you’ll need to accept help first.”
“We can look for a solution in Khat treatment together.”

#5 Get support group help. 

You can encourage peer support by looking into 12 Step groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) for a loved one, and Al-Anon for yourself. SMART Recovery and Rational Recovery are other options that have helped people find support for addiction, too.

Aftercare

Before formal treatment program for addiction finished, rehab staff should prepare a comprehensive aftercare plan. This plan can include continued visits with your rehab counselor. Or, you will receive referrals to local support such as a therapist, sponsor ,or other members of the recovery community.

Aftercare services are often provided in the form of:

• Counseling / Group Therapy. These include Cognitive Behavioral Therapy (CBT), relaxation training, motivational interviewing, self-monitoring of consumption, goal setting, management of withdrawal and coping with anxiety.
• Follow-up medical care. Supervised medical management is recommended for those with a history of Khat abuse due to various physical and psychological complications that may arise as a result of long term Khat use.
• Sober living communities – Sober living facilities offer a prolonged stay for recovering individuals who have quit Khat and look forward to a drug free life, but are just not ready to step into possible triggering environments.

Questions?

We hope to have answered most of your questions about identifying and treating stimulant problems. Remember that khat is a psychoactive drug. And drug problems are medical problems!

If you are ready for help, ask!

IF you still have additional questions, please leave them in section at the end. We love to hear from our readers! And we’ll try to respond to your question personally.

Reference Sources: DEA: Khat

EUROPE PMC: Khat use: history and heart failure.

NCBI: Kat and its use: an historical perspective.

NCBI: Khat use: lifestyle or addiction?

NCBI: Khat use: lifestyle or addiction?

NCBI: Chemistry, pharmacology, and toxicology of khat (catha edulis forsk): a review.