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Table 7 Main indicators of problematic khat use identified through the emic approach

From: What constitutes problematic khat use? An exploratory mixed methods study in Ethiopia

(1) Quantity of khat: Using large quantities of khat, the use of increasing amounts of khat through time and the need to use other substances to either enhance the stimulating effects of the khat or to reverse the excessive stimulant effect of khat (mirqana). (2) Time of use: use of khat in the morning (yejebena), taking too much time to use khat-throughout the day or night and using during unscheduled times and if the users’ life is dominated by khat use. (3) Repeated excessive negative impact during or after using khat, including negative behavioral effects (e.g., mirqana). (4) Withdrawal effects when reducing the amount used or cessation of use, and problematic management of these withdrawal effects. (5) Craving for khat. (6) Desire to stop or cut down use but unable to do so. (7) Social and occupational impairments resulting from khat use (e.g., limited time or no time for socializing, poor self-care, and giving up social responsibilities or activities; being overlooked for social responsibilities; inability to carry out responsibilities within family or work; not having time or money for recreational activities). (8) Using khat even when it is hazardous (e.g., operating machinery, driving a car). (9) Major negative impact on finances. (10) Physical harms resulting from khat use or from withdrawals.