title: Does areca nut use lead to dependence?
abstract: BACKGROUND
  The areca nut is consumed by approximately 10% of the world's population, and its consumption is associated with long-term health risks, with or without tobacco additives. However, it is not known whether its use is associated with a dependence syndrome, as is seen with other psychoactive substances.
  
  
  OBJECTIVE
  To examine whether areca nut usage (with or without tobacco additives) could lead to the development of a dependence syndrome.
  
  
  METHODS
  Three groups: [a] persons using areca nut preparations without tobacco additives [n=98]; [b] persons using areca nut preparations with tobacco additives [n=44]; and [c] 'Non-users' were systematically assessed using a checklist for the use of areca or areca+tobacco products, patterns of use, presence of a dependence syndrome in users, features of stimulant withdrawal and desired/beneficial effects.
  
  
  RESULTS
  38.8% and 40.8% of the 'areca' group satisfied definitions of current substance-dependence according to DSM-IV and ICD-10 criteria respectively. 79.5% of the areca+tobacco group satisfied criteria for current dependent use according to both DSM-IV and ICD-10 criteria. Both the groups reported a well-delineated withdrawal syndrome and similar attributions for desirable effects of use.
  
  
  CONCLUSIONS
  Areca nut use by itself and more so with tobacco additives, is associated with the development of a dependence syndrome in a substantial numbers of users.
authors.affiliation: Deaddiction Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India. vbenegal@gmail.com <vbenegal@gmail.com>
authors.forename: Vivek
authors.initials: V
authors.lastname: Benegal
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Rajkumar
authors.forename: Kesavan
authors.initials: K
authors.lastname: Muralidharan
mesh_terms: D000328:Adult; D001114:Areca / Q000009:adverse effects*; D003627:Data Interpretation, Statistical; D005260:Female; D005544:Forecasting; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011634:Public Health; D012959:Socioeconomic Factors; D013375:Substance Withdrawal Syndrome / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D062789:Tobacco Products