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March 2018

What Is an Addictive Disorder?

Author Affiliations
  • 1Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
  • 2Office of the Director, National Institute on Drug Abuse, Bethesda, Maryland
JAMA Psychiatry. 2018;75(3):229-230. doi:10.1001/jamapsychiatry.2017.4356

The publication of the DSM-5 and the evolution of the Research Domain Criteria have rekindled interest in defining what an addictive disorder truly is. The study of Lee et al,1 by postulating the existence of betel use disorder, offers an opportunity to examine this important question.

Betel quid, a masticatory mixture of Areca catechu nut wrapped in a betel leaf, is the fourth most commonly self-administered psychoactive substance in the world (after caffeine, alcohol, and tobacco). Its principal active agent is arecoline, a nonselective agonist of the muscarinic acetylcholine receptors. It is estimated that more than 600 million people use betel quid worldwide. Currently, most use occurs in the Asia Pacific region, but it may be spreading through Asian migrant communities. Despite its psychoactive properties, high prevalence of use, and adverse consequences, it is unknown whether betel use can lead to the development of a substance use disorder (ie, betel use disorder [BUD]). To address this issue, Lee et al1 created the Asian Betel Quid Consortium, which conducted 6 coordinated cross-sectional studies across East Asia, Southeast Asia, and South Asia.

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