Background Approximately 600 million people worldwide regularly chew betel-quid(BQ), and 10% of the Taiwanese use it. Arecoline has a chemical structure comparable to nicotine. In animal experimental studies, also found that its have the effect of antidepressant. Despite the understanding of pharmacological reactions for BQ, little is known about the the relationship between the addiction of BQ chewing and anxiety, depression and oral potentially malignant disorders (OPMD). Purpose To investigate the factors that are associated with addictive use of BQ among chewers, and the relationship between BQ addiction and anxiety, depress and oral potentially malignant disorders. Material and methods To investigate these issues, we conducted a community-based cross-sectional study using probability proportionate to size sampling to recruit participants. All participants were recruited from Taiwan Kaohsiung city. All chewers were evaluated for BQ addiction using the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) criteria, anxiety was measured using the Beck Anxiety Inventory (BAI), and depress was using Center for Epidemiologic Studies Depression Scale (CES-D). Results A total of 250 BQ chewers and 156 non-chewers recruited from 123 BQ shops and 59 convenience stores in Kaohsiung city, respectively. According to DSM-IV and DSM-V, the chewers who had BQ addiction were more likely to be male, be married, have low educational level, low income, and work as a laborer. A five-BQ increase in the amount consumed , a one-day increase in the use, a one-year younger at starting age, and swallowed BQ juice were associated with a 1.01-1.03, 1.3-1.5, 1.02-1.1 and 2.2-2.9-fold significant risk of contracting BQ addiction, respectively. As compared to non-addictive chewers, addictive chewers had a higher anxiety (aOR=2.1). No BQ dependence/addiction chewers in minimal level of anxiety is lower than non-chewers (aOR=0.4-0.5). As compared to non-addiction chewers, addiction chewers had 3.7-fold risk of OPMD. Conclusions This study found that BQ addiction chewers are associated with lower socioeconomic status, and substance use characteristics. Addictive BQ use is positively related to amounts, days, years of chewing and swallowed BQ juice, and negatively related to starting age. Non-chewers had higher anxiety than non dependence/addiction chewers. Addictive chewers had high risk in minimal level of anxiety and OPMD.