Importance Betel-quid (BQ) is the fourth most popular psychoactive agent worldwide. An emerging trend across Asia is the addictive consumption of BQ, which is associated with oral cancer and other health consequences.

Objective To investigate the validity and pattern of DSM-5–defined BQ use disorder (BUD) and its association with oral potentially malignant disorder (OPMD) among Asian populations.

Design, Setting, and Participants In-person interviews were conducted from January 1, 2009, to February 28, 2010, among a random sample of 8922 noninstitutionalized adults from the Asian Betel-quid Consortium study, an Asian representative survey of 6 BQ-endemic populations. Statistical analysis was performed from January 1, 2015, to December 31, 2016.

Main Outcomes and Measures Participants were evaluated for BUD using DSM-5 criteria for substance use disorder and for OPMD using a clinical oral examination. Current users of BQ with 0 to 1 symptoms were classified as having no BUD, those with 2 to 3 symptoms as having mild BUD, those with 4 to 5 symptoms as having moderate BUD, and those with 6 or more symptoms as having severe BUD.

Results Among the 8922 participants (4564 women and 4358 men; mean [SD] age, 44.2 [0.2] years), DSM-5 symptoms showed sufficient unidimensionality to act as a valid measure for BUD. The 12-month prevalence of DSM-5–defined BUD in the 6 study populations was 18.0% (mild BUD, 3.2%; moderate BUD, 4.3%; and severe BUD, 10.5%). The 12-month proportion of DSM-5–defined BUD among current users of BQ was 86.0% (mild BUD, 15.5%; moderate BUD, 20.6%; and severe BUD, 50.0%). Sex, age, low educational level, smoking, and drinking were significantly associated with BUD. Among individuals who used BQ, family use, high frequency of use, and amount of BQ used were significantly linked to moderate to severe BUD. Compared with individuals who did not use BQ, those who used BQ and had no BUD showed a 22.0-fold (95% CI, 4.3-112.4) risk of OPMD (P < .001), whereas those with mild BUD showed a 9.6-fold (95% CI, 1.8-56.8) risk (P = .01), those with moderate BUD showed a 35.5-fold (95% CI, 4.3-292.3) risk (P = .001), and those with severe BUD showed a 27.5-fold (95% CI, 1.6-461.4) risk of OPMD (P = .02). Individuals with moderate to severe BUD who used BQ and had the symptom of tolerance had a 153.4-fold (95% CI, 33.4-703.6) higher risk of OPMD than those who did not use BQ, and those with moderate to severe BUD who used BQ and had a larger amount or longer history of BQ use had an 88.9-fold (95% CI, 16.6-476.5) higher risk of OPMD than those who did not use BQ.

Conclusions and Relevance This international study gathered data about BQ users across 6 Asian populations, and it demonstrates that DSM-5 symptoms could fulfill a BUD construct. Most current Asian users of BQ already have BUD, which is correlated with risk of OPMD. Among individuals with moderate to severe BUD who used BQ, tolerance and a larger amount or longer history of BQ use are the key symptoms that correlated with enhanced risk of OPMD. These findings play an important role in providing a new indication of an additional psychiatric management plan for users of BQ who have BUD.

重要性 槟榔（BQ）是全球第四大最受欢迎的精神活性剂。亚洲各地的一种新兴趋势是BQ的成瘾性消费，它与口腔癌和其他健康后果相关。

目的 探讨亚洲人群中DSM-5定义的BQ使用障碍（BUD）的有效性和模式及其与口腔潜在恶性疾病（OPMD）的关系。

设计，设置和参与者 从2009年1月1日至2010年2月28日，进行了面对面访谈，对来自亚洲槟榔联盟的一项研究中的8922名非机构化成年人进行了随机抽样，这是一项针对6种BQ流行病的亚洲代表性调查。人口。从2015年1月1日至2016年12月31日进行统计分析。

主要结果和措施 使用DSM-5物质使用障碍标准评估参与者的BUD ，并使用临床口腔检查评估参与者的OPMD。当前具有0到1个症状的BQ用户被分类为没有BUD，具有2到3个症状的BQ属于轻度BUD，具有4到5个症状的BQ属于中度BUD，具有6个或更多症状的BQ属于严重BUD。

结果 在8922名参与者中（4564名女性和4358名男性；平均[SD]年龄为44.2 [0.2]岁），DSM-5症状表现出足够的一维性，可以作为BUD的有效量度。在6个研究人群中，DSM-5定义的BUD的12个月患病率为18.0％（轻度BUD 3.2％；中度BUD 4.3％；重度BUD 10.5％）。DSM-5的12个月比例–当前BQ用户中定义的BUD为86.0％（轻度BUD为15.5％；中度BUD为20.6％；重度BUD为50.0％）。性别，年龄，文化程度低，吸烟和饮酒与BUD显着相关。在使用BQ的个体中，家庭使用，高使用频率和BQ使用量与中度至重度BUD显着相关。与不使用BQ的个体相比，使用BQ且没有BUD的个体显示OPMD的风险高22.0倍（95％CI，4.3-112.4）（P  <.001），而轻度BUD的个体显示出9.6-OPMD。（95％CI，1.8-56.8）风险（P  = .01），具有中等BUD的人群显示35.5倍（95％CI，4.3-292.3）风险（P  = .001），而具有严重BUD的人群显示35.5倍（95％CI，4.3-292.3）。OPMD的27.5倍（95％CI，1.6-461.4）风险（P = .02）。使用BQ并具有耐受症状的中重度BUD个体的OPMD风险比不使用BQ的人和使用BQ的中重度BUD的人高153.4倍（95％CI，33.4-703.6）与不使用BQ的人相比，使用BQ且使用BQ的历史更长或更长时间的人，其OPMD风险高88.9倍（95％CI，16.6-476.5）。

结论与相关性 这项国际研究收集了6个亚洲人口中BQ使用者的数据，并证明了DSM-5症状可以满足BUD构造。当前，亚洲的大多数BQ用户已经患有BUD，这与OPMD的风险有关。在使用BQ的中度至重度BUD个体中，耐受性和大量或更长的BQ使用史是与OPMD风险增加相关的关键症状。这些发现在为患有BUD的BQ用户提供新的精神病治疗计划新指示方面起着重要作用。