Betel quid is a carcinogenic psychoactive preparation, often containing tobacco, which is widely consumed in Myanmar. Studies on betel quid dependence have illuminated betel quid chewers’ demographics and reasons for chewing, but dependence formation is not fully understood. This study aims to describe the social context, patterns of use, and subjective experiences of betel quid chewing among novice and dependent chewers, and to analyze the hidden structural factors that contribute to the emergence of betel quid dependence. Data on the subjective and objective aspects of betel quid chewing were collected through a five-month ethnographic study in Mandalay, Myanmar. Betel quid chewers were recruited for in-depth interviews and focus group discussions. The data were analyzed within a critical medical anthropology framework. Male betel quid chewers begin to chew out of curiosity and social pressure. They believe that chewing boosts their sexual attractiveness and increases their negotiation power with peers and family. Dependence develops when chewers continue chewing beyond the initiation stage. Chewing is used as a social lubricant that enhances social gatherings and work activities. Weak law enforcement and the need for employment among the unskilled rural population encourage the emergence of betel quid economies. Betel quid is used as a drug food to facilitate hard work and to self-medicate suffering caused by exploitative socioeconomic conditions. Betel quid chewing becomes indispensable as a part of the chewer’s habitus. The economic conditions of chewers need to be improved and community-based programs initiated to discourage early initiation of betel quid chewing.