A dependency syndrome related to areca nut use: some medical and psychological aspects among areca nut users in the Gujarat community in the UK

Use of betel nut (areca nut) and its products is widespread, particularly i n the Indo-Chinese continents, being the fourth most widely used substance after tobacco, alcohol and caffeine, affecting approximately 20% of the wor ld's population. Betel nut, with or without admired tobacco, is widely used among UK Indo-Asian immigrants, particularly Gujurate speakers. To dare mo st research has concentrated on oral submucous fibrosis and malignancy. Thi s paper reports detailed socio-demographic, clinical, laboratory and psycho logical studies in 11 current and former heavy betel nut users, referred by an Oral Medicine Unit in NW London. The patients, nine males, two females, had a high incidence of cardiovascular disease and truncal obesity. Labora tory investigations showed a high incidence of reduced serum (B12) levels ( 4/9) and raised urinary cotinine levels (6/11), although none were current cigarette smokers. These findings are consistent with heavy usage of tobacc o-areca combinations by this group. Routine biochemical and haematological investigations and clinical examination revealed no consistent abnormalitie s. Subjects had used areca for an average of 35 years with the mean age of first use being 13 years. Most subjects reported beneficial psychosocial ef fects. Ten subjects reported cessation withdrawal effects with the mean Sev erity of Dependence Score of 7.3. These findings are consistent with the ex istence of a dependency syndrome among those who use areca nut products. Fu rther research is required to delineate the relative contributions of areca nut and tobacco to this clinical picture. Use of the areca nut, especially with tobacco, represents an area of health prevention among the UK minorit y populations that has, to date, been overlooked.