Substance abuse in Somali combatants; and more

December 10, 2007

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




Dr. Michael Gerhard Odenwald
University of Konstanz
Universitaetsstr. 10
Konstanz, Baden-Württemberg 78457
0049/7531/88-4601 (fax)

Related 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




Prof. Kamaldeep Bhui
Centre for Psychiatry Barts & The London Medical School

Clustered environments and randomized genes: a fundamental distinction between conventional and genetic Epidemiology

In a cross-sectional study, George Davey Smith and colleagues show why observational studies can produce misleading claims regarding potential causal factors for disease, and they illustrate the use of Mendelian randomization to study environmentally modifiable risk factors.

Citation: Davey Smith G, Lawlor DA, Harbord R, Timpson N, Day I, et al. (2007) Clustered environments and randomized genes: A fundamental distinction between conventional and genetic epidemiology. PLoS Med 4(12): e352. doi:10.1371/journal.pmed.0040352




Prof. George Davey Smith
University of Bristol
Dept of Social Medicine
Canynge Hall
Whiteladies Road
Bristol, England BS8 2PR
United Kingdom
44-(0)117-9287325 (fax)

About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit

Everything published by PLoS Medicine is Open Access: freely available for anyone to read, download, redistribute and otherwise use, as long as the authorship is properly attributed.


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