The modern habit of chewing areca nut is practiced by approximately one in ten people worldwide. It is usually chewed with betel leaf and other ingredients such as calcium hydroxide, some spices, and tobacco, and it leaves the mouth a deep red color. It resembles nutmeg in shape and color, but it has a very different taste, slightly bitter and intense. It is a drug used primarily in tropical Asia and the Pacific, and it is considered the fourth most popular psychoactive substance on the planet, only behind alcohol, caffeine, and nicotine. Deeply rooted in some cultures, its history has a much older origin than previously thought.