Specialists aren’t sure just how addictive khat really is, but at least one country feels like it’s addictive enough to warrant rehab.

If you would stumble upon a khat plant, you probably wouldn’t think much of it. But to millions of people, this plant is known as “green gold”. Its leaves contain an amphetamine-like stimulant which causes excitement and euphoria among others. In countries such as Kenya, Uganda, and Ethiopia, it’s analogous to coca leaves in South America and betel nut in Asia.

Legally, khat is banned in many countries, although chewing khat is still commonplace in Ethiopia and the wider Horn of Africa region. But physicians are torn about it. The World Health Organization (WHO) classified it in 1980 as a “drug of abuse that can produce psychological dependence”, but the WHO does not consider khat addiction to be seriously problematic.

An estimated 5 to 10 million people globally use khat on a daily basis, and it’s not uncommon to hear stories like the one from Yonas Getu Molla. He started chewing khat as a student, to be awake more time and better focus on studying in the night. But he would then have trouble falling asleep and finding an appetite, so he would often turn to alcohol, which opened up another addiction. It’s often said that khat helps you focus, but in the long term, its effects can be quite severe.

Furthermore, while the addictiveness of khat is somewhat debatable, its propensity to push people towards alcohol is undeniable. Welday Hagos, a clinical psychologist and director of Ethiopia’s only free, long-term drug and alcohol rehab center says that 80% of the 500 patients who have stayed there since it opened in 2015 started out chewing khat.

“After that they add cigarettes, after that they add alcohol. That’s why it is the main gate for different drugs,” said Welday, who leads the facility called Substance Rehabilitation Centre. “We are not on the right track,” he said. “We have to increase the knowledge of our population of the consequences of khat chewing.”

Many residents of the Substance Rehabilitation Centre say that khat alone, without alcohol or other drugs, was enough to lead their life to ruin. But just like with other addictive substances, quitting khat can be quite difficult. So in addition to drugs and alcohol, the Substance Rehabilitation Centre is also helping people quit their khat addiction. It’s a small step, but a novel approach nonetheless — and a firm stand in the heart of one of khat’s strongholds.

Elsewhere, in Yemen, the majority of adult men consume khat on a regular basis. Consumption rates are so high that 40% of the country’s sparse water supply goes towards irrigating it. Prioritizing khat has played a major role in a recent Yemen famine.