Khat (Catha edulis) is a plant with stimulant effects due to cathinone and cathine, commonly used for increased alertness, appetite suppression, and social or religious gatherings. It is popular in the Horn of Africa (Ethiopia, Somalia, Kenya, Djibouti, Eritrea) and the Arabian Peninsula (especially Yemen). In these regions, khat chewing is deeply embedded in cultural traditions, business meetings, and daily social interactions. In the U.S., khat is classified as a Schedule I controlled substance, and while small immigrant communities continue its use, it is largely illegal due to concerns about stimulant abuse and dependence.
Pathophysiology of Khat Withdrawal
• Neurotransmitter Dysregulation:
• Khat contains cathinone, a stimulant that enhances the release of dopamine, norepinephrine, and serotonin, similar to amphetamines.
• Chronic use leads to dopaminergic depletion, resulting in anhedonia, fatigue, and depressive symptoms upon cessation.
• Noradrenergic dysfunction contributes to restlessness, irritability, and increased sleep disturbances.
• Serotonergic imbalance may cause mood instability and depressive symptoms.
• Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction:
• Chronic khat use induces stress responses, leading to cortisol dysregulation, which may contribute to withdrawal-associated anxiety and irritability.
• Autonomic Rebound:
• Withdrawal leads to a sympathetic crash, manifesting as fatigue, excessive sleep, and low motivation.
• Neuroadaptation & Plasticity Changes:
• Chronic use reduces synaptic plasticity in reward-related brain regions, leading to prolonged cravings and difficulty in maintaining abstinence.
Management of Khat Withdrawal
• Supportive Care:
• Encourage hydration, nutrition, and sleep hygiene to assist in physiological recovery.
• Pharmacological Interventions (no FDA-approved medication specifically for khat withdrawal, but options include):
• Antidepressants (e.g., SSRIs, SNRIs) for depressive symptoms.
• Benzodiazepines (short-term use) for severe agitation or insomnia.
• Alpha-2 agonists (e.g., clonidine) to manage autonomic symptoms.
• Atypical antipsychotics if psychotic symptoms emerge.
• Behavioral & Psychological Support:
• Cognitive-Behavioral Therapy (CBT) to address cravings and relapse prevention.
• Motivational Interviewing (MI) to enhance commitment to quitting.
• Group therapy & social support for long-term abstinence.
• Monitoring & Long-Term Care:
• Regular follow-ups for relapse prevention and psychosocial support.
Reference:
Duresso SW, Bruno R, Matthews AJ, Ferguson SG. Khat withdrawal symptoms among chronic khat users following a quit attempt: An ecological momentary assessment study. Psychol Addict Behav. 2018 May;32(3):320-326. doi: 10.1037/adb0000368. PMID: 29771560.