Khat Use and Trait Anger: Effects on Affect Regulation during an Acute Stressful Challenge

Khat ( Catha edulis ) is a widely used stimulating drug often consumed in daily routine in Yemen and East African countries. Chewing khat acutely elicits states of euphoria and feelings of well-being which later shift into emotional instability and low mood. Little is known about emotional regulation in habitual khat chewers. In this study, we compared self-reports on trait anger as well as positive and negative affect responses to a mental arithmetic challenge. Participants included 135 men and women from Yemen who chew khat regularly, occasionally or not at all. Participants attended a laboratory session that involved resting periods and performing a math challenge. Analyses of variance and regression show that regular khat chewing is associated with higher trait anger, more pronounced negative responses during stress and less pronounced positive emotional states. These results suggest that regular khat chewing is associated with disturbances in emotion regulation processes. Copyright © 2011 S. Karger AG, Basel Received: March 2, 2011 Accepted: June 19, 2011 Published online: August 23, 2011 European Addiction c Re e s ar h Mustafa al’Absi, PhD Khat Research Program (KRP), University of Minnesota School of Medicine 1035 University Drive Duluth, MN 55812 (USA) Tel. +1 218 726 7144, E-Mail malabsi @ umn.edu © 2011 S. Karger AG, Basel Accessible online at: www.karger.com/ear Bongard /al’Absi /Khalil /Al Habori Eur Addict Res 2011;17:285–291 286 sessions are initially characterized by positive feelings of optimism, alertness, and a general sense of euphoria and well-being [1, 9] . After about 2 h, however, chewers start reporting higher tension, irritation, sluggishness and a general low mood [1, 2] . This negative tone usually lasts for several hours. However, the described dynamics vary between individuals and also depend on the type of khat that is chewed [4, 10] . Although these extensive observations have been discussed in connection with the effects of khat chewing on acute mood states, little systematic research has addressed mood and emotion regulation among habitual khat chewers. For example, work assessing emotional or mood states in a standardized way are virtually missing, with a few exceptions. Nencini et al. [11] used questionnaires and visual analog scales for mood assessments during a khat chewing session of habitual consumers. Their results indicated that euphoria, improved subjective intellectual efficiency and alertness were associated with khat consumption in 10 of 14 participants, but 4 participants experienced only dysphoria and mild sedation during the session as did all participants in the postchewing period. More recently, Gelaye et al. [12] investigated risk factors for violent behavior among male college students in Ethiopia and found that students who were regular khat chewers had a 1.45 odds ratio for violent behavior compared to those who did not chew khat. These observations suggest that khat chewers were less efficient in regulating negative emotional experiences. Emotion regulation mechanisms, however, come particularly into play when individuals are confronted with stressful situations. For example, in relation to nicotine, an often used substance, we were able to demonstrate that hyporesponsiveness to mental and social stress predicted shorter time to relapse [13] . Further, high trait anger was associated with greater increases in state anger, withdrawal symptoms and craving during the first 24 h of abstinence from nicotine. High trait anger was also associated with increased risk for early relapse [14] . Smokers high in trait anger have greater mood difficulties during abstinence and are more vulnerable to early relapse than smokers with low trait anger. Research with other stimulant users suggests a role for anger, aggression and other emotion regulation factors in cocaine and amphetamine consumers [15–17] . These findings implicate trait anger to be associated with poor emotional regulation and vulnerability to substance misuse and relapse. The objectives of the current study were to investigate possible differences in trait anger and anger coping behavior in khat chewers and to examine the extent to which habitual khat chewing is associated with altered mood states during mental stress. We expected that regular khat users report greater trait anger, and will report more negative and less positive affect during a lab stressor compared to those who do not use khat.