{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:34:57Z","timestamp":1787801697269,"version":"build-2784847793"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2006,6,9]],"date-time":"2006-06-09T00:00:00Z","timestamp":1149811200000},"content-version":"vor","delay-in-days":2260,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction Biology"],"published-print":{"date-parts":[[2000,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Use of betel nut (areca nut) and its products is widespread, particularly in the Indo\u2010Chinese continents, being the fourth most widely used substance after tobacco, alcohol and caffeine, affecting approximately 20% of the world's population. Betel nut, with or without admixed tobacco, is widely used among UK Indo\u2010Asian immigrants, particularly Gujurate speakers. To date most research has concentrated on oral submucous fibrosis and malignancy. This paper reports detailed socio\u2010demographic, clinical, laboratory and psychological 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. Laboratory 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 tobacco\u2010areca combinations by this group. Routine biochemical and haematological investigations and clinical examination revealed no consistent abnormalities. 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 effects. Ten subjects reported cessation withdrawal effects with the mean Severity of Dependence Score of 7.3. These findings are consistent with the existence of a dependency syndrome among those who use areca nut products. Further 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 minority populations that has, to date, been overlooked.<\/jats:p>","DOI":"10.1080\/13556210050003766","type":"journal-article","created":{"date-parts":[[2002,7,26]],"date-time":"2002-07-26T15:39:11Z","timestamp":1027697951000},"page":"173-179","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":98,"title":["A dependency syndrome related to areca nut use: some medical and psychological aspects among areca nut users in the Gujarat community in the UK"],"prefix":"10.1111","volume":"5","author":[{"given":"A. R.","family":"Winstock","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. R.","family":"Trivedy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. A. A. S.","family":"Warnakulasuriya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. J.","family":"Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,6,9]]},"reference":[{"key":"e_1_2_1_2_2","first-page":"236","article-title":"Betel nut chewing in retrospect","volume":"21","author":"Burton\u2010Bradley B.","year":"1978","journal-title":"Papua New Guinea Med J"},{"key":"e_1_2_1_3_2","first-page":"51","article-title":"Areca nut A review","volume":"26","author":"Arjungi KN.","year":"1976","journal-title":"Arzneim-Forsch. (Drug Res)"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bdj.4809345"},{"key":"e_1_2_1_5_2","first-page":"1151","article-title":"Betelquid chewing habits among a sample of South Asians","volume":"75","author":"Atwal GS","year":"1996","journal-title":"J Dent Res"},{"key":"e_1_2_1_6_2","first-page":"1054","article-title":"Betel quid chewing and tobacco habits among Asian schoolchildren","volume":"76","author":"Osaman S","year":"1997","journal-title":"J Dent Res"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)18622-8"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0714.1995.tb01156.x"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0714.1994.tb00258.x"},{"key":"e_1_2_1_10_2","first-page":"572","article-title":"Betel chewing and dietary habits of chewers with and without submucous fibrosis and concomitant oral cancer","volume":"74","author":"Seedat HA","year":"1988","journal-title":"S African Med J"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(98)70543-2"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870040406"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02203205"},{"key":"e_1_2_1_14_2","first-page":"935","article-title":"Cardiovascular responses to betel nut chewing","volume":"92","author":"Chu NS.","year":"1993","journal-title":"J Formos Med Assoc"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.2466\/pr0.1996.79.2.451"},{"key":"e_1_2_1_16_2","first-page":"106","article-title":"Effects of betel chewing on RR interval variation","volume":"94","author":"Chu NS.","year":"1995","journal-title":"J Formos Med Assoc"},{"key":"e_1_2_1_17_2","first-page":"167","article-title":"The effects of betel chewing on electroencephagraphic activity: spectral analysis and topographic mapping","volume":"93","author":"Chu NS.","year":"1994","journal-title":"J Formos Med Assoc"},{"key":"e_1_2_1_18_2","first-page":"143","article-title":"The effect of betel nut on human performance","volume":"33","author":"Frewer LJ.","year":"1990","journal-title":"Papua New Guinea Med J"},{"key":"e_1_2_1_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/258627a0"},{"key":"e_1_2_1_20_2","first-page":"326","article-title":"\u2018Betelmania\u2019, Betel quid chewing by Cambodian women in the United States and its potential health effects","volume":"160","author":"Pickwell SM","year":"1994","journal-title":"West J Med"},{"key":"e_1_2_1_21_2","unstructured":"GriffithsP.Qat use in London: a study of qat use among a sample of Somalis living in London.DPI Publication No.26. Home Office UK.1998."},{"key":"e_1_2_1_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00846549"},{"key":"e_1_2_1_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.314.7078.420"},{"key":"e_1_2_1_24_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1995.9056072.x"},{"key":"e_1_2_1_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1997.tb02953.x"},{"key":"e_1_2_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)02507-X"},{"key":"e_1_2_1_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.1991.tb00401.x"},{"key":"e_1_2_1_28_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.84.3.399"}],"container-title":["Addiction Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1080%2F13556210050003766","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1080\/13556210050003766","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,29]],"date-time":"2023-10-29T11:30:40Z","timestamp":1698579040000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1080\/13556210050003766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,4]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2000,4]]}},"alternative-id":["10.1080\/13556210050003766"],"URL":"https:\/\/doi.org\/10.1080\/13556210050003766","archive":["Portico"],"relation":{},"ISSN":["1355-6215","1369-1600"],"issn-type":[{"value":"1355-6215","type":"print"},{"value":"1369-1600","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,4]]},"assertion":[{"value":"2006-06-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}