Exploring the Perceptions of Indian Mental Health Professionals Regarding Areca (Betel) Nut Products: A Cross-sectional Study

Abstract

Background: Areca nut (AN) and AN products (ANPs) are commonly used as psychoactive substances with marked dependence potential. Scant information exists on the Indian mental health professionals’ (MHPs) knowledge of AN-ANPs, attitude toward AN-ANP use/users, and behavior regarding their clients’ AN-ANP use. To address this gap, a survey was undertaken to assess MHPs’ knowledge, attitudes, and behavioral responses toward AN-ANP use and addiction. Methods: We developed a pretested, customized questionnaire and conducted a cross-sectional online survey among a random sample of MHPs. Results: The 209 respondents included 91 psychiatrists, 105 clinical psychologists, and 13 other MHPs from diverse settings. Among them, 46.89% believed that AN-ANP use does not fit the definition of abuse/addiction as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or International Classification of Diseases 10th Revision (ICD-10)/ICD-11. Among the psychiatrists, clinical psychologists, and other MHPs, 60.4%, 48.6%, and 61.5% were unaware of any AN-ANP cessation protocols. The addictive potential of AN-ANP with tobacco was rated as severe by 68.1% of psychiatrists and 51.4% of clinical psychologists; 46.2% of other MHPs rated it as moderate. The addictive potential of AN-ANP without tobacco was rated as moderate by 50.5% of clinical psychologists and mild by 46.2% of psychiatrists. Of the sample, 67.46% discussed the harmful effects of AN-ANPs with clients, while 74.6% said a few or none of their clients sought help for AN-ANP cessation. Conclusion: Major lacunae were detected in the understanding of Indian MHPs about the addictive potential of AN-ANPs, management aspects, etc. An urgent need has been revealed for sensitization programs on AN-ANPs and the development of evidence-based cessation protocols.