• Vivek Benegal, Ravi P Rajkumar, and Kesavan Muralidharan.
• Deaddiction Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India. vbenegal@gmail.com <vbenegal@gmail.com>
• Drug Alcohol Depend. 2008 Sep 1; 97 (1-2): 114-21.

BackgroundThe 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.ObjectiveTo examine whether areca nut usage (with or without tobacco additives) could lead to the development of a dependence syndrome.MethodsThree 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.Results38.8% 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.ConclusionAreca 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.

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