Khat can be addictive. Among regular users, roughly 40 to 50 percent meet clinical criteria for dependence, and the pattern looks similar to other stimulant drugs: tolerance builds, cravings develop, and quitting triggers real withdrawal symptoms. That said, khat is considerably milder than amphetamines, and the World Health Organization has not recommended it for international scheduling, noting that its “potential for abuse and dependence is low” compared to controlled stimulants. The reality falls somewhere in between: khat is not as gripping as harder drugs, but regular chewing can absolutely lead to a habit that’s difficult to break.
How Khat Works in the Brain
Fresh khat leaves contain cathinone, a compound structurally related to amphetamine. When you chew the leaves, cathinone is absorbed through the lining of your mouth and digestive tract, then crosses into the brain, where it increases dopamine levels at nerve connections. This is the same basic mechanism behind amphetamine and other stimulants: a flood of dopamine that produces feelings of alertness, euphoria, confidence, and reduced appetite.
The key difference is potency. In animal studies comparing khat extract to amphetamine, amphetamines produced similar behavioral effects at dramatically lower doses. Khat’s stimulant punch is real but substantially weaker, which is one reason the habit tends to involve hours of slow chewing rather than the rapid, intense highs associated with stronger stimulants. The leaves also contain cathine, a secondary compound with milder stimulant properties that contributes to the overall effect.
How Many Users Become Dependent
A cross-sectional study of khat users in Yemen found that 48.9 percent of male users and 31.8 percent of female users screened positive for dependence. Those numbers are consistent with findings from khat-using communities in the UK (51 percent), Saudi Arabia (52 percent), and Australia (44 percent). A separate study applying the DSM-5 diagnostic framework, the standard clinical tool for diagnosing substance use disorders, found that among current users, 10.5 percent had a mild disorder, 8.8 percent had a moderate disorder, and 54.5 percent met criteria for severe khat use disorder. The researchers concluded that khat use disorder is a valid diagnosis that behaves consistently with other recognized substance dependencies.
These rates may seem high, but context matters. The studies sampled regular, established users rather than everyone who has ever tried khat. Still, the numbers make clear that frequent khat chewing carries meaningful addiction risk, particularly for daily users.
Signs of Tolerance and Compulsive Use
Tolerance develops with regular use. In one study of chronic khat chewers, two-thirds reported needing more khat over time to achieve the same effect. Nearly three-quarters said they used more than they originally intended, and about 79 percent expressed a desire to cut down or stop but struggled to do so. Perhaps most telling, 94 percent reported withdrawal symptoms when they tried to quit, and 94 percent continued chewing despite knowing it was causing health problems.
Khat use typically begins at a young age and often settles into a daily routine. In communities where khat is culturally embedded, afternoon chewing sessions can last several hours. Chronic users sometimes prioritize buying khat over meeting basic household needs, a pattern that mirrors compulsive use seen with other addictive substances.
What Withdrawal Feels Like
Quitting khat after regular use produces a recognizable withdrawal syndrome. An ecological momentary assessment study, which tracked users in real time after a quit attempt, found that symptoms including depression, cravings, nervousness, fatigue, restlessness, irritability, and poor motivation all spiked during the first week, peaking around day seven. Cravings, irritability, and restlessness typically returned to baseline levels during the second week.
Compared to withdrawal from alcohol or opioids, khat withdrawal is not physically dangerous. The WHO describes these symptoms as “mild” and notes they “resolve rapidly.” But “mild” in a clinical sense doesn’t mean easy to endure. The combination of low energy, depressed mood, and strong cravings during that first week is often enough to pull people back into use, which is exactly how the cycle of dependence sustains itself.
Effects on Thinking and Mental Health
Long-term khat use is associated with measurable cognitive decline across several domains. A systematic review of human studies found deficits in learning, short-term and working memory, decision-making, motor coordination, processing speed, and cognitive flexibility, which is your brain’s ability to switch between tasks or adjust to new rules. These impairments overlap with patterns seen in users of other long-term stimulants.
On the psychiatric side, daily khat use has been linked to higher rates of psychosis, depression, and self-harm. It’s not always clear whether khat triggers these conditions directly or whether people with existing vulnerabilities are drawn to heavy use, but the association is consistent across multiple studies and populations.
Cardiovascular Risks of Chronic Use
The stimulant compounds in khat trigger the release of adrenaline and noradrenaline, which raise heart rate and blood pressure every time you chew. Over years of daily use, that repeated cardiovascular stress takes a toll. Khat chewers have higher rates of hypertension than non-chewers, with one study finding hypertension or use of blood pressure medication in 13.4 percent of chewers versus 10.7 percent of non-chewers.
The heart attack risk is where the numbers get stark. Mild khat use did not significantly raise the risk of acute myocardial infarction, but moderate chewers had roughly 7.6 times the risk, and heavy chewers faced over 22 times the risk compared to non-users. Chronic use can also cause the heart muscle to thicken and weaken over time, a condition called cardiomyopathy, and can promote blood clot formation by triggering blood vessel constriction and increased platelet clumping. Long-term chewers are also at elevated risk for diabetes and unhealthy cholesterol levels.
Legal Status Varies Widely
Khat occupies an unusual legal gray zone. The WHO has reviewed it multiple times and determined the threat to public health is “not significant enough to warrant international control,” so it has no scheduling status under international drug treaties. Individual countries have made their own decisions. The United Kingdom classified khat as a Class C controlled substance in 2014. In the United States, cathinone (the active compound) is a Schedule I controlled substance, which effectively makes fresh khat illegal, though enforcement varies. In many countries across East Africa and the Arabian Peninsula, khat remains legal and culturally integrated into daily life.
The gap between the WHO’s relatively relaxed assessment and the high dependence rates found in user populations reflects a genuine tension. Khat is not pharmacologically comparable to cocaine or methamphetamine, but for people who chew daily over years, the combination of psychological dependence, cognitive decline, and cardiovascular damage adds up to serious harm.