Khat Use Patterns, Associated Features Psychological and Neuropsychological Problems in Counseling Seeking Student Sample in Ethiopia

Abstract

In study 1, guided self-report assessment using tablet computers was employed to present standard psychological instruments: TLFB (khat), SRQ-20, PCL-5, LEC-5, AUDIT and SOCRATES. Moreover, socio-demographic, economic variables, and functioning problems due to mental health problems were assessed. The study intended to describe khat use, psychological problems, and motivation to change and to determine associated factors of khat use among Ethiopian university students who are seeking khat counseling. A convenient sample of 717 counselling-seeking khat using students participated in a cross-sectional study. Five hundred seventy-five participants' results were included into the final analysis. Translated versions of instruments were available in the two widely spoken languages (Amharic and Afan Oromoo) together with English. Participants had the chance to select preferred languages. The participants reported high alcohol and khat use. The AUDIT mean score was 15.79 (SD = 8.45), which is in the range of medium risk alcohol use. Scores above the cut-off of 8 (hazardous alcohol use) were reached by 47.1%. The sample showed high khat use in the past month (M = 31.55 bundles, SD = 28.53), 17% indicated as highly problematic khat use. The sample was extremely burdened with psychiatric and comorbid problems that is, 21.6% reported functioning problems due to past mental disorder, 60.2% scored above the cut-off for current common mental disorders, 37.9% screened positive for PTSD. More than half of the respondents reported most traumatizing events on the PCL-5, including human-made and natural accidents, abuses, and loss of loved ones. The reported incidents happened either directly to participants or respondents witnessed the incidents. Motivation to change, measured by SOCRATES, indicated low scores in all three subscales. Small to medium intercorrelations between variables were detected, and in hierarchical regression models, higher motivation to change khat use was associated with higher use of the substance. Study 2 investigated the relationship between neuropsychological executive functions and the amount of khat and alcohol use controlling for intelligence and psychopathology. Three hundred twenty-two khat using students of Jimma university were recruited in a cross-sectional study (data of 286 were included into the analysis). Screening using tablet computers for CMD, PTSD, alcohol use, khat use and trauma load and, furthermore trained counselors evaluated neuropsychological executive functions: Tower of Hanoi (ToH), Corsi block-tapping task (CBT), intelligence RAVEN’s Standard Progressive Matrices (RAVEN’s SPM) and psychotic symptoms (khat-induced or real) in a one-to-one session. The study revealed participants are regular and heavy khat users, in the 28 days before the assessment that is on average 29.0 standard units (SD = 27.9) and 14.4 use days (SD= 8.64). Participants experiencing psychotic symptoms 6 hours after khat use accounted for 25% of the sample. The results from the ToH and CBT assessment results were in a normal range. The neuropsychological executive cognitive functions and khat use were weakly related. Executive functions were not associated with alcohol use, trauma load and common mental problems but they were correlated with the intelligence test results. The two studies revealed that Jimma university students are highly burdened with khat and alcohol use, trauma exposure, and psychological disorders. Despite of heavy substance use and extreme burden with comorbid psychiatric problems, executive cognitive functions seemed to be normal in the group. This is most probably related to the not yet chronic use patterns. Prevention and intervention strategies will have a good chance to reduce the negative impact of long-term khat use. Further research is required to develop programs that are practical. A particular approach is mandatory for female substance-using students. More validation studies are needed so that the psychopathological, neuropsychological and intelligence tests should have country- or East African-specific norms for interpretation. The results obtained from the studies will help to develop research instruments that can be used for screening purposes.