Let’s Quit Betel Quid

By Soe Moe

 

ABOUT a week ago, on my way to work, after pass­ing Hledan junction and crossing the Hledan line-bus stop on Insein Road, I saw a passenger on a stationary bus open a window and spit betel juice onto the road. This scene has become an all-too-common sight in Myanmar.

 

Anyone walking up the stairs of an apartment building in Yan­gon will invariably see, wheth­er they want to or not, the red-stained walls on the stairwell corners, splattered with betel juice. All over Yangon, in neigh­bourhoods, main roads, alley­ways, and other crowded places, we are seeing more and more betel quid shops, whether mobile from pushcarts or fixed in one place. This means that betel quid consumption has become part of people’s daily living environment, not only in cities and large towns but also in rural villages.

 

Moreover, the habit of buying and consuming betel quid among drivers of long-distance buses and cars, under the pretext of staying awake while driving, has made be­tel consumption seem justifiable. Betel quid use is expanding day by day. Beyond the traditional offer­ing of “betel, tobacco, and tea” in Burmese hospitality, its use has widened and is now causing dam­age not only to the health of the majority of consumers but also to their family income. The gradual expansion of betel quid consump­tion can be instantly observed by looking at the current usage sit­uation. Furthermore, even those with health knowledge can see that, compared to the entire pop­ulation, they are still a very small minority.

 

I believe that those who con­sider betel chewing a mere social habit and downplay the danger­ous consequences and side effects of its use are likely more numer­ous in our country.

 

What is Betel Quid?

 

Betel quid is a combination of substances chewed for their psychoactive, stimulating effects. It is generally wrapped in a betel leaf. The original ingredients are:

 

Areca Nut: The main addictive ingredient.

 

Betel Leaf: The leaf from the betel plant.

 

Slaked Lime or Shell Lime: An alkaline substance that helps release the active ingredients from the areca nut.

 

Other Additives: Tobacco, sweeteners, spices, and processed tobacco products like Hman See (cured tobacco), Forty-Fif­ty, Night Two, etc.

 

Reasons for Betel Quid Addiction

 

Addiction to betel quid is caused not only by chemistry but also by psychological factors and traditions.

 

Chemical Addiction (Arecol­ine)

 

Areca nut contains a chemi­cal called Arecoline.

 

This chemical stimulates the brain similarly to nicotine, caus­ing the release of neurotransmit­ters like dopamine and serotonin.

 

Dopamine is a chemical that creates a feeling of satisfaction, leading to addiction and encour­aging further use.

 

With long-term use, the brain becomes dependent on dopamine. If consumption stops, intense cravings and withdrawal symp­toms occur.

 

Psychological and Behav­ioural Addiction

 

Habit: Preparing and chewing betel quid becomes a ritual, often associated with socializing, post-meal relaxation, or stress relief.

 

Social Pressure: Betel quid is an important part of hospitality and friendship traditions, making it difficult to quit.

 

Stress Relief: Many people use betel quid to relieve stress or to improve concentration.

 

Health Side Effects of Betel Chewing

 

The World Health Organiza­tion (WHO) has classified betel quid as a top-priority carcino­gen. Potential health conditions include:

 

Oral Cancer: The most significant and major risk.

 

Oral Submucous Fibrosis (OSF): The mouth becomes stiff, leading to cracked lips, difficulty opening the mouth, and pain, which can eventually lead to oral cancer.

 

White or Brown Patches in the Mouth (Leukoplakia/Eryth­roplakia): Pre-cancerous signs.

 

Other Cancers: Can cause cancer of the lips, tongue, cheeks, and palate.

 

Other Cancers: Increases the risk of throat, oesophagus, and stomach cancer.

 

Dental and Oral Prob­lems: Tooth decay, betel-stained teeth, and gum disease.

 

Increased Risk of Heart Disease and Diabetes.

 

Negative Effects on Preg­nant Women.

 

How to Quit Betel Quid?

 

Set a Quit Date.

 

Once you’ve decided to quit, you must set a date. There is no single “best” time to quit; the best time is when you are comfortable with your work, social, and home life commitments. The date you set should not be more than two weeks away.

 

Reduce Consumption Be­fore the Quit Date.

 

While strong-willed individu­als can stop abruptly, for others, gradually reducing consumption until stopping completely on the set date is the best method. It is important to note what situ­ations or reasons trigger your chewing and to avoid them. For example, if you usually chew after meals or when meeting friends outside, make sure betel quid is not easily available dur­ing mealtimes, don’t bring any when you go out, and don’t ask for any from friends. Changing these behaviours is necessary. For those with a strong addiction, it helps to have sugar-free candy, gum, or roasted sunflower seeds on hand to chew. Furthermore, you should inform your friends and acquaintances that you are quitting.

 

The Quit Date Arrives. When the set date arrives, you must absolutely stop consuming betel quid. If a craving arises, try to distract yourself from it. Change where you usually eat your meals. Immerse yourself in another activity to pass the time. Engage in sports. Bring substi­tute foods with you (e.g., gum, sunflower seeds) to consume.

 

The First Week of Quitting

 

The withdrawal symptoms that appear after quitting are usu­ally most severe in the first week. Common symptoms include:

 

Intense cravings for betel quid.

 

Anxiety, irritability, and mood swings.

 

Difficulty concentrating.

Insomnia (or drowsiness).

Feeling tired and lethargic.

Increased appetite.

Tendency to feel depressed.

 

These symptoms typically last for the first week or so after quitting. When a strong craving arises, you can dispel it by tak­ing deep breaths or doing some exercise. Eating fresh fruits and vegetables, drinking six to eight glasses of water daily, walking, running, cycling, or swimming are all beneficial.

 

The Second Week of Quit­ting

 

Cravings may persist. If they do, be patient and resist for as long as possible; the desire will eventually subside. As a substi­tute, chew gum or eat sunflower seeds to get through the time.

 

The Third Week of Quitting

 

By this week, you should have successfully overcome the addiction to betel quid (and tobac­co). You must try not to give in to temptation and chew again even once. If you consume it again, you can easily become re-addicted. Quitting betel quid (and tobac­co) is difficult, and most people cannot quit in a single attempt. A relapse is not a failure; by trying to quit again, you can progress towards permanent cessation.

 

Betel quid addicts must quit, as they become aware of the great health risks and the daily dam­age to their family’s finances and income. Equally, if not more im­portant, is educating the majority of young people who are not yet users to never start.

 

For those addicted to betel quid who want to quit, they often do not know the methods to do so. Therefore, I would like to sug­gest that Universities of Dental Medicine and large Dental De­partments, which directly deal with various types of oral can­cer linked to betel quid chewing, should consider opening “Quit Corners” or “Quit Centres for Be­tel Quid Chewing” – small depart­ments for those who wish to quit, providing counselling, advice, and treatment.