Khat addiction, toombak and shamma: the harms and how to quit

Is khat addictive, and what are its health effects?

Yes, it can be. Chewing khat every day for long periods, with the wad of leaves held in the cheek for hours (what many people in Yemen call takhzin), can lead to psychological dependence, which is what people usually mean by khat addiction. Khat's health effects include sleeplessness, loss of appetite, raised blood pressure and a faster heartbeat, mood swings, and lost time and family income. The risk grows with frequent, heavy chewing, especially once it becomes a daily habit you feel you cannot do without. There is no known safe amount, though: each chewing session can raise blood pressure and heart rate for a few hours, and the risk is greater for people with heart problems or a mental illness.

Khat (also spelled qat) is the fresh leaves and tender shoots of the khat tree, and it is used in Yemen, the Jazan region of Saudi Arabia and East Africa. Its main active substance, cathinone, resembles amphetamine in its chemical structure and in how it affects the nervous system, according to a 2017 review in the Eastern Mediterranean Health Journal, published by the World Health Organization. Soon after chewing starts, a person feels energetic, cheerful and talkative. A quieter, more inward phase follows, and then a gradual comedown that can bring restlessness, irritability and low mood. Its legal status differs from country to country: it is widely accepted in Yemen, for example, while Saudi Arabia, the UK and other European countries ban it.

Why can khat addiction develop when khat is so socially accepted?

The unpleasant after-effects as khat wears off push many people to keep chewing without a break. And because chewing is so normal, it is hard to notice the moment a social session turns into a need, since everyone around you is doing the same thing. The same 2017 review notes that regular chewers can feel restless, irritable, unable to concentrate and less able to control their impulses at the time of day they usually chew. It also cites a study in which 31% of 204 khat users of Yemeni origin living in the UK met the criteria for dependence in the American diagnostic manual (DSM-IV).

The habit may have gone too far if you notice that you:

• Chew almost every day, and feel very low or on edge if you miss a session.
• Spend many hours a day getting and chewing khat, at the expense of work or family.
• Spend household money, or money meant for your children, on it.
• Have tried to cut down or stop more than once and could not.
• Carry on despite the sleeplessness, health problems or family arguments it causes.

How does khat affect sleep, mood, appetite and the heart?

Scientific reviews list a range of harms linked with frequent, long-term chewing, especially heavy use:

• Sleep: difficulty falling asleep at night, and feeling exhausted and sluggish the next morning.
• Appetite and digestion: poor appetite that can lead to malnutrition, plus constipation and gastritis (inflammation of the stomach lining).
• Heart and circulation: raised blood pressure and a faster heart rate; some studies and case reports also link khat with heart complications and strokes.
• Mouth: inflammation of the lining of the mouth, gum disease, and changes in the tissue where the khat is held.
• Liver: cases of liver inflammation and damage have been described in regular chewers; they are uncommon but can be serious.
• Pregnancy: a mother chewing khat is linked with lower birth weight in her baby.
• Memory and temper: weaker attention and memory, and getting angry more quickly under stress.
• Home and money: long hours and a large share of the family's income go on khat, which can hit family life hard.

The 2017 Eastern Mediterranean Health Journal review cautions that many of these studies did not carefully rule out other causes, such as the cigarettes often smoked alongside khat or pesticides on the leaves. The picture is not complete yet, but the warning signs come up often enough to take them seriously.

Is khat linked with depression, anxiety and psychosis?

The honest answer: studies show a link, but whether khat actually causes these problems has not been settled. A systematic review published in BMJ Open in 2022 pooled 35 studies with almost 32,000 participants from five countries. It found that psychiatric symptoms in general, and psychological distress in particular, were more common among people who use khat, while no clear link with anxiety or with psychosis was shown when each was analyzed on its own. The researchers rated the strength of this evidence as "very low", because every study looked at people at a single point in time instead of following them over the years, and the studies measured things in very different ways.

The link may run both ways. Khat may make psychological symptoms worse, and people who already live with depression, anxiety or trauma may turn to it to feel better for a while; but, according to the 2017 Eastern Mediterranean Health Journal review, it raises their risk of psychotic symptoms. The same review adds that moderate use does not seem to cause a mental disorder by itself, and that the harm grows with heavy use and in people who are more vulnerable, such as those with an earlier mental illness, trauma or heavy stress, and teenagers.

Khat-related psychosis

More than 20 cases of khat-related psychosis have been described in the medical literature, meaning a loss of touch with reality with unrealistic suspicions or hallucinations. Most of these people had been chewing heavily before the symptoms started. Most recovered within two to four weeks of stopping, but most went on to have similar episodes again. In people who already have a psychotic disorder, the risk of relapse rises with large amounts, daily or night-time chewing and very long sessions, especially if they stop their medication. So never stop your psychiatric medicine on your own, and discuss any change with your doctor.

If you notice lasting sadness and a loss of interest in things, read about the symptoms of depression. When a mental health condition and dependence on a substance occur together, this is called dual diagnosis, and both need to be treated together.

Toombak and shamma: smokeless tobacco, but not safe

Toombak (widely used in Sudan; the same name is also given to a type of shamma in southern Yemen) and shamma, also spelled shammah (known in Yemen and parts of Saudi Arabia and Algeria), are kinds of tobacco placed in the mouth rather than smoked, and their names can vary from country to country. Many people assume they are milder than cigarettes because there is no smoke, but the US National Cancer Institute is clear that there is no safe form of tobacco, and that smokeless tobacco is not a safe substitute for smoking.

• Addiction: it contains nicotine. According to a global report released in 2014 by the US Centers for Disease Control and Prevention (CDC) and the National Cancer Institute, people who use it show signs of dependence similar to those of smokers, including withdrawal symptoms when they stop.
• Cancer: the same report (2014) found sufficient evidence that it causes cancer of the mouth, the esophagus (food pipe) and the pancreas.
• Mouth and heart: white patches in the mouth that can come before cancer, gum disease, and it may also cause heart disease.

Sudanese toombak carries a particular danger. A 2021 study in the journal Toxicology Reports found that its samples contain extremely high levels of tobacco-specific cancer-causing substances, thousands of times above the maximum limits set for these substances in Swedish snus (a European type of oral tobacco). The researchers cite an older estimate from 1989 that about 81% of mouth cancers in Sudan occur in toombak users, appearing at the very spot where it is placed.

In Yemen, a study of 346 men in the Dawan Valley in Hadramout, published in the journal Tobacco Induced Diseases in 2015, found that the odds of having gum pockets (a sign of inflammation in the tissues that hold the teeth in place) were about 6.6 times higher in current shamma users than in men who had never used it. The study shows a link and does not, on its own, prove the cause.

What happens when you stop khat or toombak?

Dependence on khat is mainly psychological, and stopping does not usually cause dangerous physical symptoms, but the first days can be uncomfortable. Sources describe symptoms such as restlessness, irritability, difficulty concentrating, strong cravings to chew, disturbed sleep, sluggishness and low mood, and some people also get a slight tremor and nightmares. A 2020 review in the journal Cureus points out that low mood and depression are among the biggest concerns after quitting, because they raise the chance of going back to khat or turning to another substance.

When you stop toombak or shamma, you may get nicotine withdrawal symptoms, just as people do when they quit smoking. Knowing about these symptoms in advance helps you not to read them as failure. If you also take sleeping pills, sedatives or psychiatric medicines alongside khat, do not stop or change them on your own; talk it through with your doctor. To learn more about withdrawal in general, read our guide to drug withdrawal symptoms.

How to quit khat and toombak: practical steps

There are still no medicines proven to treat khat dependence specifically, as the 2017 Eastern Mediterranean Health Journal review notes, and the few studies available relied on cognitive behavioral therapy and health education for the person and their family. For tobacco, the World Health Organization (2026) says that counseling together with medication decided on by a doctor can more than double the chance of quitting successfully. These steps can help you get started:

1. Write down your reasons: your health, your sleep, your children, your money. Go back to them whenever a craving hits.
2. Choose a start date and tell someone you trust, so they can back you up.
3. Know your triggers: the daily chewing session, certain friends, the afternoon hours, boredom. Plan exactly what you will do at those times.
4. Fill the gap: walking, visiting family, exercise, or prayer and reading in the hours you used to chew, with regular times for sleep and meals.
5. Treat a craving like a wave: it builds and then fades. Wait it out, and change where you are or what you are doing.
6. Don't swap one substance for another: quitting khat by smoking more, using more shamma or taking sleeping pills without a prescription only moves the problem instead of solving it.
7. Ask for help early if you keep going back. This is common and does not mean you have failed. Our article on relapse prevention helps you understand why it happens.

How can family support someone who wants to quit, without blame or shaming?

When khat or shamma is part of everyday life, someone who wants to quit can feel very alone. This is where family support makes a big difference:

• Talk calmly about the effects you can see (sleep, money, short temper) instead of accusing or insulting.
• Praise every small step.
• Don't offer khat or tobacco at gatherings, and suggest other family activities instead.
• Encourage specialist help if psychological symptoms appear, and learn how families can support someone without enabling drug use.

When should you seek help, and where can you find treatment in Egypt?

Seek specialist help if you have tried to stop and could not, if chewing comes with severe insomnia, depression or ongoing anxiety, if unrealistic suspicions, hearing voices or aggression appear, or if you use khat with other substances or take psychiatric medicines.

If you have moved to Egypt from Yemen, Sudan or elsewhere and brought this habit with you, the change of surroundings can be a chance to quit, even with the loneliness and pressure of being far from home. You can contact Oxygen Center in Damanhour on +20 101 687 0711 (phone and WhatsApp) or +20 45 320 0011, or call the hotline of Egypt's Fund for Drug Control and Treatment of Addiction on 16023, which works around the clock and offers confidential addiction treatment through partner centers.

How is khat or tobacco dependence treated at the center?

Treatment usually starts with an outpatient appointment with a doctor to assess your pattern of use and your mental and physical health, and to check whether other substances, depression or anxiety also need treatment. After that, the plan may include therapy sessions and behavior modification to deal with cravings and empty time, with the family involved. If psychotic symptoms appear or other substances are involved, the doctor may decide that more intensive care is needed.

The center sees people aged 15 and over (under 18 with a guardian's consent). Outpatient appointments, therapy sessions and behavior modification are open to men and women, while inpatient stays are for males only. Families can also come on their own first, to ask questions and understand how to help.