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.

在公布DSM-5和研究领域标准的演进已经在界定什么上瘾的障碍确实是重新燃起兴趣。Lee等人的研究[ ^1]通过假设槟榔使用障碍的存在，为研究这一重要问题提供了机会。

槟榔，是槟榔包裹在槟榔叶中的咀嚼混合物，是世界上第四大最常见的自我管理的精神活性物质（仅次于咖啡因，酒精和烟草）。它的主要活性剂是槟榔碱，一种毒蕈碱型乙酰胆碱受体的非选择性激动剂。据估计，全世界有超过6亿人在使用槟榔。目前，大多数使用情况发生在亚太地区，但可能正在亚洲移民社区中传播。尽管其具有精神活性，高使用率和不良后果，但槟榔使用是否会导致物质使用障碍（即，槟榔使用障碍[BUD]）的发生尚不得而知。为了解决这个问题，Lee等¹ 成立了亚洲槟榔Quid联盟，该联盟在东亚，东南亚和南亚进行了6项协调的横断面研究。