The Sulawesi findings invite a comparison with the current global situation of betel nut use, because the ancient and modern are connected in ways that the study makes explicit.

Betel nut is the world’s fourth most widely used psychoactive substance.

Approximately 600 to 700 million people use it regularly — that is, at least once a week.

The majority of these users are in Asia: Taiwan, India, Bangladesh, Papua New Guinea, Indonesia, Vietnam, Myanmar, and many other countries and territories.

In many of these contexts, betel nut use is deeply culturally embedded.

In parts of India and Taiwan, offering and accepting betel nut is a social ritual that marks hospitality, affection, and welcome.