Betel‐quid dependence domains and syndrome associated with betel‐quid ingredients among chewers: anAsian multi‐country evidence

Abstract Aims Betel‐quid ( BQ ) contains biologically psychoactive ingredients; however, data are limited concerning the symptoms and syndrome of BQ dependence among chewers. The aims of this study were to evaluate the ingredients‐associated BQ dependence syndrome and country‐specific chewing features and behaviour for BQ dependence among chewers from six A sian communities. Design An intercountry A sian B etel‐quid C onsortium study. Setting Six A sian general communities in T aiwan, Mainland C hina, I ndonesia, M alaysia, S ri L anka and N epal. Participants Six multi‐stage random samples of BQ chewers in the A sian B etel‐quid C onsortium study ( n = 2078). Measurements All chewers were evaluated for BQ dependence using the DSM‐IV and ICD ‐10 criteria. Findings The 12‐month BQ dependence rate was 12.5–92.6% and 47.9–99.3% ( P = 0.023) among tobacco‐free and tobacco‐added BQ chewers across the six A sian communities, with a higher dependence rate in chewers who used tobacco‐free BQ with lime added than without (23.3–95.6% versus 4.0%, P ≤ 0.001). T aiwanese and H unanese BQ chewers both notably endorsed the dependency domain of ‘time spent chewing’. ‘Tolerance’ and ‘withdrawal’ were the major dependence domains associated with the N epalese and Indonesian chewers, with high BQ dependence rates. M alaysian and S ri L ankan chewers formed a BQ dependence cluster linked closely to ‘craving’. In S ri L anka, the quantity consumed explained 90.5% ( P < 0.001) of the excess dependence risk for tobacco‐added use, and could be a mediator between tobacco‐derived psychoactive effect and BQ dependence development. Conclusions DSM‐IV criteria for dependence apply to a significant proportion of betel quid users in A sian communities, more so if they use it with tobacco or lime.