Understanding betel nut addiction: a review of harmful consequences, underlying neurobiology, and emerging intervention strategies

Betel nut is the fourth most commonly used psychoactive substance globally and is particularly prevalent in the Asia-Pacific region. Betel nut chewing is closely associated with a variety of health hazards, including oral cancer, cardiovascular diseases, and metabolic syndrome. This article reviews the epidemiological characteristics, health hazards, neurobiological mechanisms, and intervention strategies of betel nut addiction. The major active component in betel nut, arecoline, leads to addiction by modulating the cholinergic, dopaminergic, and glutamatergic systems, with the involvement of the gut-brain axis and immune-inflammatory responses. In terms of intervention strategies, pharmacological treatments (such as nicotinic receptor modulators), neuromodulation techniques (such as real-time functional magnetic resonance imaging neurofeedback), cognitive-behavioral therapy, and public health policies have shown potential efficacy. Future research should focus on the development of precision medicine strategies and interdisciplinary integrated intervention models.