A Review of Intervention Strategies for Areca Nut Use Cessation

Abstract

Background: Areca nut (AN) is one of the world’s most widely used drugs, especially in Asia-Pacific, causing dependence and multiple adverse health impacts. The International Agency for Research on Cancer (IARC) has classified it as a type-1 carcinogen. Despite evidence of harms, its use is culturally ingrained in many regions worldwide; harm perception is low; and the availability of intervention strategies is limited. Methods: To identify the range and efficacy of interventional studies on AN use cessation, a narrative review of studies published between 1990 and 2021 was undertaken using selected electronic databases (PubMed, Embase, and Scopus). Results: Three types of interventions were identified: educational, psychological, and pharmacological. Overall, educational interventions significantly enhanced knowledge regarding harms related to AN use. Some psychological interventions reported enhancement of motivation to quit as well as helped in reduction/cessation of AN use. Two pharmacological studies on psychiatric patients with depressive disorders and AN use found that antidepressants helped in reducing/cessation of AN use. Conclusion: Overall, the number of interventional studies on AN cessation is limited, and most studies have measured the short-term effects of the intervention. The role of pharmacotherapeutic interventions needs to be evaluated for AN cessation, and evidence-based psychosocial interventions need to be developed for AN cessation. Furthermore, longitudinal research using adequate sample sizes and longer follow-up durations are needed to establish interventions in this important area.

A Patient With Oral Discomfort and Reduced Oral Aperture

“…2 The areca nut is designated as a type-1 carcinogen by the International Agency for Research on Cancer. 2,5 Chewing areca nuts causes abrasion and inflammation of the oral mucosa, which allows areca nut components to penetrate the oral mucosa. 3,6 Alkaloids in areca nuts promotecollagensynthesis,resultinginoralmucosalfibrosis.…”

“…1 Although OSMF is irreversible, cessation of areca nut chewing decreases its progression and reduces the risk of oral squamous cell carcinoma.Educationalandbehavioralinterventionsforcessationofareca nut chewing have been successful in randomized clinical trials. 5,10 Patients should be encouraged to not smoke or chew tobacco, to decrease alcohol intake, and to correct nutritional deficiencies. Oral physical therapy, 1 which involves mouth opening exercises or fibrous band massage, may be helpful for patients with reduced oral aperture due to OSMF.…”

“…8 Surgical excision of fibrotic bands and reconstruction with tissue flaps may be considered for patients with advanced OSMF. 1,5,6…”

“…Although there are no randomized clinical trials of treatments for OSMF, corticosteroids applied topically or injected into areas of oral fibrosis may reduce oral discomfort . Surgical excision of fibrotic bands and reconstruction with tissue flaps may be considered for patients with advanced OSMF …”

Towards a replacement therapy for stimulant betel quid dependence: A proof of concept study

“…Yet very little research effort focuses on developing strategies to decrease SBQ dependence, which if effective, will decrease an individual's exposure to SBQ and reduce the risk of oral cancer. In Taiwan and other countries, counselling based cessation programs for SBQ are rare, 13 result in improved health education about SBQ chewing, rarely have long term follow up and have small impact on quitting of chewing 29,30 . The most effective method to treat SBQ SUD requires the development of a culturally sensitive replacement for SBQ with slaked lime.…”