The combination of the addictive properties of arecoline, the cultural normalization of use, and the severe health consequences creates a public health challenge in these countries that is comparable, in some respects, to the tobacco crisis in Western countries in the twentieth century.

The ancient Sulawesi evidence is relevant to this modern public health context in a way that the researchers acknowledge: understanding the deep history of a behavior, including its origins and its pharmacological mechanisms, can inform efforts to address its modern consequences.

If betel nut use was habitual and potentially addictive among Ice Age foragers — if the pharmacological trap that drives continued use despite tooth destruction operated on Pleistocene brains as it operates on modern ones — that understanding can inform how health systems and communities approach the challenge of changing deeply ingrained behaviors.

The study’s finding that the ancient form of use (sucking whole nuts) was different from the modern form (chewing processed quids with lime) may also have implications for harm-reduction approaches.