Stimulant addiction (including khat/miraa)

What it is

Stimulant use disorder covers problematic use of substances that speed up brain activity, producing alertness, energy and euphoria, followed by a “crash.” In East Africa the most significant is khat (miraa, muguka), chewed widely and woven into social and economic life, alongside amphetamine-type substances and cocaine.

Khat occupies a genuinely complex place: legal and culturally embedded in parts of the region, an important livelihood for many farmers and traders, yet capable of producing dependence and harm in heavy users. Acknowledging both realities honestly, neither moral panic nor denial, is the only useful approach. Regular heavy khat use can lead to dependence, with cravings and low, irritable, sleepless states when stopping.

What heavy use can do

Beyond dependence, heavy stimulant use can bring insomnia, anxiety, irritability, weight loss, dental and oral problems (with khat), high blood pressure and heart strain, and relationship, financial and work difficulties. In some people, heavy khat or other stimulant use can trigger psychotic symptoms (paranoia, hallucinations), which usually settle after stopping but can be serious (see our guide on psychosis caused by substances).

How common is it

In East Africa, khat is by far the most widely used stimulant, chewed by a significant share of adults in some communities, with heavy daily use carrying the greatest risk of dependence. Cocaine and amphetamine-type stimulants are less common here than in some regions but are present and rising in urban areas. Dependence is most likely with frequent, heavy, long-term use.

What causes it

There is no single cause. The risk of dependence rises with frequent and heavy use, early use, easy availability, a family history of addiction, and using stimulants to cope with stress, low mood, or the demands of long working hours. Stimulants act strongly on the brain's reward system, and the cycle of a high followed by a crash pulls a person back, which is part of why heavy use is hard to stop.

How it is diagnosed

A clinician makes the diagnosis through an honest conversation about how much and how often a person uses, whether they can cut down, cravings, and the effect on sleep, mood, health, money, and relationships. There is no test that diagnoses the disorder itself. The clinician also checks for anxiety, low mood, heart strain, and any psychotic symptoms linked to heavy use.

How it is treated

There are no established medicines specifically for stimulant use disorder; treatment is psychological and supportive, and it helps. CBT, motivational interviewing and contingency-based approaches support people to reduce and stop, alongside managing low mood and sleep during the early withdrawal period and treating any co-occurring anxiety, depression or psychosis. Practical support around the routines, social settings and, for some, the livelihood tied to use makes change more sustainable.

The aim is not stigma toward communities where khat is normal, but support for those for whom use has become harmful or beyond their control.

Stimulant use in the African context

Services for stimulant problems are thin across the region, and khat in particular sits in a genuine tension: legal and culturally rooted in many areas, and a livelihood for farmers and traders, yet able to cause dependence and harm in heavy users. The useful stance is support for those harmed rather than stigma toward whole communities. Cocaine and amphetamine-type stimulants are less common but rising in towns, and heavy stimulant use can trigger psychosis (see our guide on psychosis caused by substances).

Managing it day to day

Alongside support, these steps help.

• Expect a low, tired, irritable patch when cutting down, and know that it passes.
• Plan for cravings and the social settings tied to use, and have other ways to handle stress and stay alert without stimulants.
• Protect sleep and regular meals, which heavy use disrupts.
• Treat any underlying anxiety or low mood rather than using stimulants to manage them.
• Lean on supportive people, and mark progress.

Helping someone

If someone you care about uses stimulants harmfully, your support matters.

• Talk with care and without blame, at a calm moment, and avoid stigma toward the wider practice of chewing.
• Take heart symptoms, paranoia, or unusual thoughts seriously, and seek prompt help for them.
• Encourage professional help, and offer to help find it. Our find a therapist page can help.
• Support practical changes to routine and money, and stay connected.
• Look after yourself too.