Does areca nut use lead to dependence?

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. Conclusion: 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. (C) 2008 Elsevier Ireland Ltd. All rights reserved.