Commentary on Lee et al. (2014): Betel‐quid—when East encounters West

Abstract

Commentary on Lee et al. (2014): Betel-quid-when East encounters West'Dissolve flatulence and phlegm, ease hangover, facilitate digestion, eliminate toxins from overindulgence of fat and sweet foods, gourmet for everyone to enjoy.' [1] 'Many more studies now provide evidence for the carcinogenicity of betel quid without tobacco for oral cancer and for betel quid with tobacco for cancers of the oral cavity, pharynx and oesophagus. ' [2] In the late 19th to early 20th centuries, betel-quid (or betel nut) was popular among the nobles and the wealthy in Chinese society. They would carry the small, delicate betel-quid bags (or boxes) with them and gave away betelquid as a present on social occasions. Early Chinese medicine books and cookbooks [1] mention the many beneficial effects betel-quid has on health. For example, betel-quid can facilitate digestion and ease hangover.However, when the eastern stimulant betel-quid is put under the scope of modern western addiction theory and methodology, the façade is peeled away. One notorious downside is that betel-quid is identified as a human carcinogen by the World Health Organization [2]. Another dark side that is, as yet, little known concerns the probable dependence symptoms that betel-quid chewers may develop in terms of DSM-IV and ICD-10 criteria [3][4][5][6].Lee et al.[6] conducted a large-scale survey across six Asian countries to investigate betel-quid dependence symptoms and syndrome among betel-quid chewers. Three primary conclusions can be drawn from their study. First, betel-quid dependence prevalence among chewers varies largely across countries. Secondly, the amount and frequency of betel-quid consumption are critical factors that positively predict the risk of dependence. Thirdly, tobacco additives in betel-quid increase the risk of dependence in Sri Lankan chewers.The research conducted by Lee et al. [6] has at least two advantages: (i) a large sample was recruited and (ii) various betel-quid types and ingredients were evaluated. A large sample size allowed the researchers to perform higher-level statistical analysis, facilitating the understanding of complicated relationships between dependence and chewing characteristics. Types and ingredients of betel-quid vary across countries. For example, tobacco is usually added by Nepalese and Indonesian chewers, while slaked lime and betel leaf are used by Taiwanese chewers. Because various ingredients and types of betelquid were included in Lee et al.'s study, they had the ability to investigate whether these ingredients and types, in addition to being solely tobacco-additive [3], affect the risk of dependence.However, Lee et al. [6] may have overlooked the influence of tobacco smoking on betel-quid dependence. This influence was observed in a survey of chewers in Malaysia, Indonesia and Sri Lanka who chewed both tobaccoadded and tobacco-free betel-quids. Only in Sri Lankan chewers did tobacco additives increase the dependence risk. Why was this relationship between tobacco additive and dependence risk not obs...

On multifaceted inhibitory control in betel-quid-dependent chewers

“…Sugar consumption may be a critical difference between these two studies. Second, the concurrent use of substances (e.g., tobacco and alcohol) is critical while the cognitive performance of substance users is assessed (Ho, 2014(Ho, , 2021. In the current study, FTND and AUDIT are adopted to control for the dependence level of concurrent use of tobacco and alcohol in BQ chewers.…”

“…In Taiwan, BQ chewers are usually the concurrent users of cigarettes and alcohol (Chen et al, 2001;Ko et al, 1992;Wen et al, 2005). Concurrent use of cigarettes and alcohol was taken into account by adopting controls for tobacco and alcohol users (Ho, 2014(Ho, , 2021. Previous BQ studies on inhibitory control (e.g., Kong et al, 2020;Zhu et al, 2018) excluded participants who met the DSM-IV criteria for dependence on alcohol and nicotine.…”