Whatever the social context of the ancient use was, the biological dynamics that drove its continuation were the same dynamics that drive continuation in modern users.

This does not settle the debate about whether addiction is primarily biological or primarily social — the social context clearly shapes every aspect of who uses what substance, in what amounts, with what consequences.

But it does establish that the biological substrate of addiction is genuinely ancient, not a recent development produced by the specific conditions of modern life.

The study also contributes to the evidence base for understanding betel nut addiction specifically.

Betel nut addiction is a significant public health problem in the countries where it is prevalent, and treatment approaches for it are less developed than for better-studied substances like tobacco and alcohol.