Abstract

Background:

Areca-nut (AN) and added smokeless-tobacco (SLT) are considered agents that may cause addiction to betel-quid (BQ). However, the primary addictive substance in AN is not clearly understood. Objective: The present review evaluates possible addictive chemicals in AN with their mechanisms of action for progression to BQ dependence, as it is essential to overcome barriers in BQ cessation. It also identifies innovative treatment modalities in BQ cessation including the scope for research on pharmacotherapy using Monoamine-oxidase Inhibitors, Selective Serotonin Re-uptake Inhibitors and Norepinephrine Dopamine Reuptake Inhibitors. Methods: This is a narrative review on addictive properties of BQ and trials undertaken to promote cessation of SLT or AN use. Results: Twenty interventional studies, three by behavioral therapy and seventeen using pharmacotherapy were reviewed. There was heterogeneity in reported follow up times, most studies reporting data at 12 weeks with abstinence rates of 45–55% for SLT cessation and at 8 weeks with abstinence rates around 35% for AN cessation. Conclusion: Even though literature reveals a few cessation programs through behavioral support for BQ addiction, its success has been limited in certain instances mainly due to addictive properties of AN, resulting in withdrawal and relapse. Hence, in line with pharmacotherapy in tobacco smoking cessation, potential pharmacological agents to assist in cessation of SLT and AN require more attention. Several clinical trials for SLT cessation have been carried out with varying levels of success using Nicotine Replacement Therapy and Varenicline while trials on antidepressants for SLT and AN cessation are also emerging.

中文翻译：

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槟榔成瘾：对其成瘾机制和药理学管理的回顾作为一种新兴的戒烟方式

摘要

背景：

槟榔 (AN) 和添加无烟烟草 (SLT) 被认为可能导致对槟榔 (BQ) 上瘾。然而，AN 中的主要成瘾物质尚不清楚。目标：本综述评估了 AN 中可能的成瘾化学品及其进展为 BQ 依赖的作用机制，因为克服 BQ 戒断障碍至关重要。它还确定了 BQ 戒断的创新治疗方式，包括使用单胺氧化酶抑制剂、选择性血清素再摄取抑制剂和去甲肾上腺素多巴胺再摄取抑制剂进行药物治疗的研究范围。方法：这是一篇关于 BQ 的成瘾特性的叙述性评论，以及为促进停止 SLT 或 AN 使用而进行的试验。结果：回顾了 20 项干预研究，其中 3 项是行为疗法，17 项是药物疗法。报告的随访时间存在异质性，大多数研究报告的数据在 12 周时停止 SLT 的戒断率为 45-55%，而在 8 周时停止 AN 的戒断率约为 35%。结论：尽管文献揭示了一些通过行为支持 BQ 成瘾的戒烟计划，但其成功在某些情况下受到限制，主要是由于 AN 的成瘾特性，导致戒断和复发。因此，与戒烟药物治疗相一致，有助于戒烟的潜在药物需要更多关注。使用尼古丁替代疗法和伐尼克兰进行了多项戒烟临床试验，取得了不同程度的成功，同时也出现了针对 SLT 和 AN 戒烟的抗抑郁药的试验。