Alarming Rise In Substance Abuse In Somali Combatants

An alarming rise in drug-related problems amongst militia in southern and
central Somalia, which has not been under the control of any type of
government for more than a decade, is reported in a study published this
week in the open access journal PLoS Medicine.



The problems mainly relate to the excessive use of khat, a plant whose
leaves have been traditionally chewed as a stimulant in Somalia. The
leaves
contain the amphetamine-like cathinone-a potent central stimulant that is
dependence-producing and can induce psychotic symptoms, like paranoia. But
the intake of other drugs was also perceived to be prevalent by
participants in the study. These alterations in patterns of drug use imply
potential
threats for the peace-building process in general and the re-integration
of former combatants-who may have severe dependence on drugs and related
psychiatric problems-in particular.



Studies on drug use by former combatants in Western countries have
supported the hypothesis that drugs are consumed to suppress traumatic
war-related
memories but little is know about substance abuse in post-conflict zones
in Africa. This new study by Michael Odenwald (University of Konstanz,
Germany) and colleagues was initiated by peace talks in 2003 and was one
detail of an initiative that was meant to prepare the disarmament,
demobilisation and reintegration (DDR) program in Somalia.



Local interviewers conducted 8,723 interviews of armed personnel in
convenience samples-groups chosen to participate rather than randomly
selected
from the whole population. The interviewers asked the combatants about
their own use of khat and how much they thought that others in their
military
units used it and other drugs (including cannabis, tranquilizers, alcohol,
solvents and hemp seeds, the use of which is not generally acknowledged).
They found that khat use is prevalent across the whole of Somalia: more
than a third of respondents said they'd used khat in the week prior to the
interview. The highest level of self-reported khat use was in
southern/central Somalia where up to two-thirds of combatants used it, a
dramatic rise
considering that only one in five adult males used khat in these regions
in 1980. More respondents in southern/central Somalia also reported using
an
excessive amount of khat-consuming more than two bundles per day over a
week-and having sleepless nights as a side-effect. In some regions of
southern/central Somalia there was a unanimous perception of higher
consumption of other drugs amongst combatants, especially cannabis and
psychoactive tablets, implying that the previously unacknowledged use of
multiple drugs seems to exist in militia units.



The authors suggest that the use of convenience samples, necessary because
of the political conditions in Somalia, could mean that the numerical
values of these findings may be inaccurate. The overall perceived use of
khat was higher than the self-reported use and the authors suggest that
this
discrepancy is because self-reporting actually produces underestimates of
the real figures. The authors warn that future DDR programs will have to
be
prepared to deal with drug abuse on a scale formerly unknown in the
country.
















The implications of the study are discussed in a related Perspective
article by Kamaldeep Bhui and Nasir Warfa (The Centre for Psychiatry,
Barts and
The London, Queen Mary's School of Medicine and Dentistry, University of
London), who were not involved in the study. "The challenge facing
Somalia and other conflict zones," say the authors, "is that it is young
people who are most vulnerable to developmental insults, which can lead
to long-lasting and, in some instances, permanent mental health and
physical health problems. Yet it is these very people who are likely to be
recruited for warfare and are active in conflict zones; specifically young
men exposed to drug use and violence, who will then have the most
difficulty adjusting to a life free of violence."



Citation: Odenwald M, Hinkel H, Schauer E, Neuner F, Schauer M, et al.
(2007) The consumption of khat and other drugs in Somali combatants: A
cross-sectional study. PLoS Med 4(12): e341.
doi:10.1371/journal.pmed.0040341

Please click here




PLoS Medicine Perspective:



Citation: Bhui K, Warfa N (2007) Drug consumption in conflict zones in
Somalia. PLoS Med 4(12): e354. doi:10.1371/journal.pmed.0040354

Please click here





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