Common mental health problems

Tobacco Use Problems

Tobacco products contain the chemical compound nicotine, which is addictive. Other components in tobacco, especially tar, affect the respiratory system and increase the risk of lung cancer and other chronic respiratory problems. People in the rural community of Ethiopia use tobacco through smoking, chewing and putting a bolus of tobacco under the tongue. Globally about one in three adults smokes i.e. 1.2 billion people. By 2025 the number is expected to rise to more than 1.6 billion, so smoking is clearly a worldwide problem.

Immediate effects of tobacco use:

Evidence suggests that smokers are actually less able to be happy or relaxed or concentrate than non-smokers when they do not have access to tobacco. The immediate physical effects of smoking tobacco include increased blood pressure, respiration and heart rate. With regular tobacco use, levels of nicotine accumulate in the body during the day and persist overnight. Thus, daily smokers or chewers are exposed to the effects of nicotine for 24 hours a day. Nicotine stimulates the brain. Stimulation is then followed by depression and fatigue, leading the user to seek more nicotine.

Long-term effects of tobacco use:

Long-term use of tobacco can lead to a wide range of health problems including cataracts of the eye and greatly increases the risk of cardiovascular and respiratory diseases including lung cancer. Smoking during pregnancy is especially harmful as it may result in delivery of a low birth weight baby, which in turn is a risk factor for later mental and physical problems in the child. Passive smoking (when somebody is exposed to smoke through the smoking of someone else) can also cause lung cancer in adults and increases the risk of respiratory illnesses in children and sudden death in infants.

Khat Abuse

Khat is an evergreen shrub grown in east Africa and used as a stimulant. Khat contains more than 40 chemicals. Most of the stimulant effect of khat is thought to come from the chemicals cathinone and cathine. Khat can be chewed, or may be brewed as tea. It can also be swallowed with a soft drink. The prevalence of khat use in different parts of Ethiopia is variable ranging between 0.3% and 64%. People usually prefer to chew khat in groups.

Immediate effects of khat use:

People chew khat because they believe that, like tobacco, it improves their concentration. During and immediately after chewing khat, people state they feel euphoric and wakeful, and have increased energy. They are also likely to have a decreased appetite (and are consequently often underweight) and an increased body temperature. Khat can also provoke paranoia and aggressiveness.

Long-term effects of khat use:

People who have used khat for more than a few years may manifest with a range of serious symptoms including depression, anxiety, irritability, anger, sleep disturbance, fatigue, suspiciousness, hallucinations, panic attacks, suicidal thoughts, dry mouth, burned lips, worn(decayed) teeth, disturbances in heart rhythm, heart attack and loss of libido.

Cannabis (Hashish or Marijuana)

Cannabis is a dry, shredded green/brown mix of flowers, stems, seeds and leaves of the plant Cannabis sativa. It has many informal names (e.g. "ganja", "weed", "torpedo", "dope") and is usually smoked as a cigarette, but it can also be eaten. Marijuana smoke has a distinctive sweet smell. The active ingredient in cannabis is called delta-9-tetrahydrocannabionol (THC). THC has a direct effect on the brain.

Immediate effects of cannabis:

Cannabis is rapidly absorbed and metabolised when smoked, less so when ingested (although this can produce a more intense effect). The immediate effects include a sense of relaxation, increased appetite, mood change, reduced thinking capacity, suspicion and paranoia, and impairment in balance. Cannabis may also cause hallucinations, delusions, agitation and panicky feelings in vulnerable individuals. If you observe a person during or immediately after smoking, you may notice the strong smell, and the smoker may have red eyes and a flushed face.

Long-term effects of cannabis:

Long-term frequent cannabis use leads to lack of motivation and poor performance at work or in school compared to individuals who do not consume this drug. People with cannabis use problems often appear tired and seem to not care about what happens in their life, have no desire to work regularly, and have a lack of concern about the way they look. In people who have a genetic vulnerability to psychosis, using high doses of cannabis for a prolonged period may act as a trigger to induce psychotic episodes.

Management of people with cigarette, khat and cannabis use problems:

The goal for treatment of people with cigarette, khat and cannabis problems is to help them live a normal life without substance use, so that they can function normally both in their daily social life and in their work. Treatment starts by assessing the degree of motivation and motivating them to pass through the process of change in their lifestyle. It involves increasing awareness; enhancing motivation, and helping them through the process of change. The next step is to seek assistance from the nearest health facility. Advise and refer the patient for further treatment at a health centre, the nearest hospital, or a substance abuse treatment centre for further evaluation and treatment.

Epilepsy and Dementia

People with epilepsy have recurrent seizures characterised by a brief period of involuntary shaking. Some people fail to respond to antiepileptic drugs, but more than 70% who receive treatment achieve complete freedom from seizures, usually within five years of diagnosis.

Dementia is associated with an ongoing decline of the brain and its abilities, causing problems with thinking, language, memory, understanding and judgement. There is no cure for dementia and symptoms tend to get worse over time. However, there are a number of effective treatments that can help people to cope better with their symptoms and improve their quality of life.

Both epilepsy and dementia are common conditions and you are very likely to come across people with these illnesses in your community. In both cases, the early identification of epilepsy and dementia can have a big impact in terms of effective treatment and management of these problems. Knowing about these two conditions is very important especially in Ethiopia, because significant treatment gaps exist for epilepsy and dementia, particularly in rural areas.

So, providing help and support to people with these conditions will also be effective in reducing the negative effects of poverty and social inequalities within rural communities.