Use of alcohol and drugs by Norwegian employees: a pilot study using questionnaires and analysis of oral fluid

Pharmacodynamic determinants of hangover: An intravenous alcohol self-administration study in non-dependent drinkers

Alcohol hangover refers to the combination of negative mental and physical symptoms that can be experienced after an episode of alcohol consumption, typically emerging as blood alcohol concentration (BAC) approaches zero. Hangover has been associated with heavy drinking and may be relevant in the transition to alcohol use disorder (AUD). Our aim was to examine hangover prevalence and associated symptoms following intravenous alcohol self-administration (IV-ASA), and to identify possible predictors of hangover in non-dependent drinkers. Ninety-five drinkers without AUD completed an IV-ASA session. Pharmacodynamic measures of alcohol consumption included peak and average breath alcohol concentrations. Subjective measures of alcohol response included the Drug Effects Questionnaire and Biphasic Effects of Alcohol Scale. The Alcohol Hangover Scale assessed hangover symptoms from the end of the session until the following morning. 78% of participants endorsed at least one hangover symptom following IV-ASA. There was no association between hangover scores and IV-ASA measures of alcohol consumption. Additional mediation and moderation analysis revealed that self-reported intoxication was a significant mediator of the relationship between recent drinking and hangover symptoms. Hangover symptoms may be an early marker of the relationship between subjective response to alcohol and heavy drinking for those with no prior history of AUD. In particular, the effects of hangover go beyond exposure to alcohol and the individual's subjective response to this exposure is associated with their experience of hangover. Future studies should further characterize the determinants of hangover across different populations of drinkers to better understand the risk for AUD and inform prevention methods.

Gender Differences in the Association between Positive Drinking Attitudes and Alcohol-Related Problems. The WIRUS Study

Background: Alcohol consumption is deeply integrated in people's social- and work lives and, thus, constitutes a serious public health challenge. Attitudes toward drinking stand out as important predictors of drinking, but have to date been sparsely studied in employee populations. This study explores the association of employees' attitudes toward drinking with their alcohol-related problems, and whether this association is moderated by gender and employment sector. Methods: Cross-sectional data were collected from a heterogeneous sample of employees (N = 4094) at 19 Norwegian companies. Drinking attitudes were assessed using the Drinking Norms Scale. The AUDIT (Alcohol Use Disorders Identification Test) scale was then used to assess any alcohol-related problems. Data were analyzed using chi-square tests, analysis of covariance (ANCOVA), and multiple logistic regression. Results: Employees with predominantly positive drinking attitudes were almost three times as likely to report alcohol-related problems compared to employees with more negative drinking attitudes (OR = 2.75; 95% CI: 2.00-3.76). Gender moderated the association between positive drinking attitudes and alcohol-related problems (OR = 3.30; 95% CI: 2.10-5.21). The association was stronger in women (OR = 5.21; 95% CI: 3.34-8.15) than in men (OR = 3.10; 95% CI: 2.11-4.55). Employment sector did not moderate the association between drinking attitudes and alcohol-related problems. Conclusions: Employee attitudes toward alcohol should be monitored to better enable early workplace health promotion interventions targeting alcohol problems. These interventions might need to be gender-specific.

Alcohol Hangover: Underlying Biochemical, Inflammatory and Neurochemical Mechanisms

AIM

To review current alcohol hangover research in animals and humans and evaluate key evidence for contributing biological factors.

METHOD

Narrative review with alcohol hangover defined as the state the day after a single episode of heavy drinking, when the alcohol concentration in the blood approaches zero.

RESULTS

Many of the human studies of hangover are not well controlled, with subjects consuming different concentrations of alcohol over variable time periods and evaluation not blinded. Also, studies have measured different symptoms and use varying methods of measurement. Animal studies show variations with respect to the route of administration (intragastric or intraperitoneal), the behavioural tests utilised and discrepancy in the timepoint used for hangover onset. Human studies have the advantage over animal models of being able to assess subjective hangover severity and its correlation with specific behaviours and/or biochemical markers. However, animal models provide valuable insight into the neural mechanisms of hangover. Despite such limitations, several hangover models have identified pathological changes which correlate with the hangover state. We review studies examining the contribution of alcohol's metabolites, neurotransmitter changes with particular reference to glutamate, neuroinflammation and ingested congeners to hangover severity.

CONCLUSION

Alcohol metabolites, neurotransmitter alterations, inflammatory factors and mitochondrial dysfunction are the most likely factors in hangover pathology. Future research should aim to investigate the relationship between these factors and their causal role.

OK Computer? A Time Analysis of Google Searches About Symptoms

Google searches are now a popular way for individuals to seek information about the significance of common symptoms and whether they should seek medical assistance. As analysis of search patterns may help understand the demand for medical care, we examined what times over a 24-hour period and on what days of the week people searched Google for information about common symptoms.

We analysed Google searches for symptoms in the United Kingdom during the week from July 30 to August 5, 2018 using Google Trends. We recorded the time points with the highest search volume for 50 common symptoms relative to other searches, and the day of the week with the highest search peak for each particular symptom.

All of the peak searches for the symptoms we examined occurred during the night between 10pm and 8am. The majority 32/50 (64%) occurred between 3am to 6am with 12/50 (24%) between midnight and 3am. Most symptom searches were more common during the week and lowest during the weekend. Typically, searches for a particular symptom peaked at a similar time each night over the week.

Searches for symptoms are significantly more common during night-time hours, and particularly between 3 and 6am. Symptom searches show relatively stable diurnal and weekly patterns.

Google searches for health information are common and individuals regularly search for their specific symptoms before deciding whether to seek medical care.

Searches for common symptoms are significantly more likely to occur, relative to other searches, during the night-time hours and are highest during the working week and lowest at weekends.

The majority of symptom searches show relatively stable diurnal and weekly patterns.

Sex Differences in the Presence and Severity of Alcohol Hangover Symptoms

Studies have demonstrated significant sex differences in alcohol intoxication effects. In contrast, the majority of studies on the alcohol hangover phase did not investigate sex differences. Therefore, the current study examined possible sex differences in the presence and severity of alcohol hangover symptoms. Data from n = 2446 Dutch students (male = 50.7%, female = 49.3%) were analyzed. They reported the presence and severity of 22 hangover symptoms experienced after their past month heaviest drinking occasion. Subjects were categorized according to their estimated peak blood alcohol concentration (eBAC) and presence and severity of the hangover symptoms were compared between men and women. In the lowest eBAC group (0% ≤ eBAC < 0.08%), no significant sex differences were found. In the subsequent eBAC group (0.08% ≤ eBAC < 0.11%), severity of nausea was significantly higher in women than in men. In the third eBAC group (0.11% ≤ eBAC < 0.2%), women reported higher severity scores on nausea, tiredness, weakness, and dizziness than men. Men reported the presence of confusion significantly more often than women, and women reported the presence of shivering significantly more often than men. In the fourth eBAC group (0.2% ≤ eBAC < 0.3%), women reported higher severity scores on nausea and tiredness than men. In the highest eBAC group (0.3% ≤ eBAC < 0.4%), no significant sex differences were found. In conclusion, across the eBAC groups, severity scores of nausea and tiredness were higher in women than in men. However, albeit statistically significant, the observed sex differences in presence and severity of hangover symptoms were of small magnitude, and therefore, have little clinical relevance.

Alcohol and substance misuse in the construction industry

This study investigates factors contributing to the menace of alcohol and substance misuse (ASM) in the construction industry, and its mitigation. A sequential exploratory mixed-method design, involving interview and questionnaire, was used for collecting data that were subsequently analysed by thematic analysis, factor analysis and Kruskal-Wallis test. Findings suggest that the problem of ASM is largely caused and exacerbated by mental strain, site working conditions, male dominance and ineffective human resource management. Screening and educational approaches were confirmed as carrot and stick methods for mitigating the menace in the construction industry. The finding implies that by making construction companies more accountable for the well-being of their workers, a change could be brought in the industry. These changes could be incentivized by initiatives like PREVENT to mitigate the crisis currently endemic in construction. The study suggests some practical measures for tackling the menace of ASM that is bedevilling the industry.

An effective hangover treatment: Friend or foe?

Background

The purpose of this study was to examine whether drinkers would change their alcohol consumption behavior if an effective hangover treatment became available.

Methods

An online survey was held among Dutch students, aged 18–30 years, who recently had a hangover. Participants were asked (1) whether they would buy an effective hangover treatment if it became available and (2) whether using such a product would increase their alcohol consumption. In a follow-up survey, the same participants could clarify their answers in detail.

Results

A total of 1837 subjects completed the survey: 69.9% of the participants indicated they would buy an effective hangover treatment if available, 8.1% answered “no”, and 22.1% did not know. Only 13.4% stated that using such a treatment would increase their alcohol consumption. The majority of 71.6% stated it would not increase their alcohol consumption and 15.1% did not know. The follow-up survey was completed by N = 471 participants, of which 11.9% stated consuming more alcohol, 70.3% reported not to drink more alcohol, and 17.8% did not know. Motives for not consuming more alcohol were “The risk of having a hangover does not influence my drinking behavior” (24.2%), and “alcohol is a harmful substance” (20.3%).

Discussion

Social drinkers second the need for an effective hangover treatment. However, according to the vast majority of them, the availability of an effective hangover treatment would not result in an increase of alcohol consumption.

Alcohol-Related Sickness Absence of Young Employees in Norway: The Impact of Social Roles and Socioeconomic Status

Aims

First, to establish whether there are differences in alcohol-related sickness absence according to socioeconomic status and family situation among young employees in Norway. Second, if differences are found, to assess whether they can be attributed mainly to differences in drinking patterns.

Methods

A sample of young, employed adults was obtained from the fourth wave of the Young in Norway study (2005) and the data were merged with registry data from Statistics Norway (N =1611). The data were analysed using cross tables and logistic regression analysis.

Results

Being male, single, not having children and having a low income were associated with alcohol-related sickness absence, but the association was not significant on education and social status. Introducing frequencies of drinking and drinking to intoxication in the regression model attenuated some associations with alcohol-related sickness absence.

Conclusion

Alcohol-related sickness absence is more common among people who are single and without children, and more common among men than women. With the exception of income, socioeconomic factors do not seem to be important. The differences between groups appear to be only partly a result of different drinking patterns.

Alternative sampling strategies for the assessment of alcohol intake of living persons

Monitoring of alcohol consumption by living persons takes place in various contexts, amongst which workplace drug testing, driving under the influence of alcohol, driving licence regranting programs, alcohol withdrawal treatment, diagnosis of acute intoxication or fetal alcohol ingestion. The matrices that are mostly used today include blood, breath and urine. The aim of this review is to present alternative sampling strategies that allow monitoring of the alcohol consumption in living subjects. Ethanol itself, indirect (carbohydrate deficient transferrin, CDT%) as well as direct biomarkers (ethyl glucuronide, EtG; ethyl sulphate, EtS; fatty acid ethyl esters, FAEEs and phosphatidylethanol species, PEths) of ethanol consumption will be considered. This review covers dried blood spots (CDT%, EtG/EtS, PEths), dried urine spots (EtG/EtS), sweat and skin surface lipids (ethanol, EtG, FAEEs), oral fluid (ethanol, EtG), exhaled breath (PEths), hair (EtG, FAEEs), nail (EtG), meconium (EtG/EtS, FAEEs), umbilical cord and placenta (EtG/EtS and PEth 16:0/18:1). Main results, issues and considerations specific to each matrix are reported. Details about sample preparation and analytical methods are not within the scope of this review.

Use of alcohol and drugs by employees in selected business areas in Norway: a study using oral fluid testing and questionnaires

Background

Alcohol or drug use and associated hangover may reduce workplace safety and productivity and also cause sickness absence. The aims of this study were to examine (i) the use of alcohol and drugs, and (ii) reduced efficiency at work and absence due to such use among employees.

Methods

Forty-four companies were invited; half of them agreed to participate. Employees filled in a questionnaire and provided a sample of oral fluid, which was analysed for alcohol, 12 psychoactive medicinal drugs and 6 illicit drugs. Participation was voluntary and anonymous.

Results

Two thousand four hundred thirty-seven employees in eight business areas agreed to participate (92 % of those invited). By combining questionnaires and oral fluid testing, we found that 5.2 % had used psychoactive medication during the last couple of days, 1.4 % had used illicit drugs, 17.0 % had used alcohol during the last 24 h but only one person (0.04 %) was positive for alcohol in oral fluid. About 25 % reported reduced efficiency at work, and 5 % reported absence from work due to alcohol use during the past 12 months. The use of illicit drugs and binge drinking resulting in reduced efficiency and absence was most common among restaurant and bar workers and more common among men than women, whereas use of psychoactive medication was most common among healthcare, transportation and storage workers.

Conclusion

Impairment at work due to alcohol or drugs was rare, whereas reduced efficiency due to drinking was reported by a fairly large proportion. There were marked differences between some business areas, and across gender.

Prevalence of ethyl glucuronide and ethyl sulphate among patients injured when driving or at work

AIMS

Presence of EtG or EtS among patients injured when driving or at work may indicate that very low BAC or residual effects of alcohol at the time of the accident may be associated with increased accident risk. The aim of this study was to assess: whether the alcohol metabolites EtG and EtS were present in a sample of patients injured when driving or injured at work, even if their blood alcohol concentration was negative; and, if EtG and EtS were present, what characterized these patients.

METHODS

Blood samples from patients admitted for treatment of injuries at a Norwegian emergency department were tested for alcohol, EtG and EtS. All samples were also analysed for medicinal and illicit psychoactive substances.

RESULTS

One hundred and ninety-two injured patients who were admitted <12 h after injury were included in the study. EtG or EtS were the most prevalent substances in the sample (17%), and a substantial proportion of the patients who tested negative for all other substances tested positive for EtG or EtS (8%). These patients were older than the rest of the sample and drank alcohol more often, according to their self-report.

CONCLUSION

EtG and EtS were prevalent among patients injured when driving or injured at work, including patients negative for all other substances. EtG and EtS should be included in future case-control studies of psychoactive substance use among injured patients to investigate the possible association between residual alcohol effects and injuries.

Oral fluid cannabinoids in chronic frequent cannabis smokers during ad libitum cannabis smoking

Oral fluid (OF) offers a simple, non-invasive, directly observable sample collection for clinical and forensic drug testing. Given that chronic cannabis smokers often engage in drug administration multiple times daily, evaluating OF cannabinoid pharmacokinetics during ad libitum smoking is important for practical development of analytical methods and informed interpretation of test results. Eleven cannabis smokers resided in a closed research unit for 51 days, and underwent four, 5-day oral delta-9-tetrahydrocannabinol (THC) treatments. Each medication period was separated by 9 days of ad libitum cannabis smoking from 12:00 to 23:00 h daily. Ten OF samples were collected from 9:00-22:00 h on each of the last ad libitum smoking days (Study Days 4, 18, 32, and 46). As the number of cannabis cigarettes smoked increased over the study days, OF THC, cannabinol (CBN), and 11-nor-9-carboxy-THC (THCCOOH) also increased with a significant effect of time since last smoking (Δtime; range, 0.0-17.4 h) and ≥88% detection rates; concentrations on Day 4 were significantly lower than those on Days 32 and 46 but not Day 18. Within 30 min of smoking, median THC, CBN, and THCCOOH concentrations were 689 µg/L, 116 µg/L, and 147 ng/L, respectively, decreasing to 19.4 µg/L, 2.4 µg/L, and 87.6 ng/L after 10 h. Cannabidiol and 11-hydroxy-THC showed overall lower detection rates of 29 and 8.6%, respectively. Cannabinoid disposition in OF was highly influenced by Δtime and composition of smoked cannabis. Furthermore, cannabinoid OF concentrations increased over ad libitum smoking days, in parallel with increased cannabis self-administration, possibly reflecting development of increased cannabis tolerance.

Use of alcohol and drugs among health professionals in Norway: a study using data from questionnaires and samples of oral fluid

Working under the influence of drugs and/or alcohol may affect safety and job performance. However, the size of this possible problem among health professionals (HPs) is unknown. The aim of this study was threefold: (i) to analyze samples of oral fluid and self-reported data from questionnaires to investigate the prevalence of alcohol and drugs among a sample of HPs in Norway, (ii) to study self-reported absence from or impairment at work due to alcohol and/or drug use, and (iii) to examine whether such use and absence/impairment due to such use depend on socio-demographic variables.

A total of 916 of the 933 invited HPs from hospitals and pharmacies participated in the study (participation rate = 98.2%), and 81.1% were women. Associations were analyzed in bi-variate cross tables with Chi-square statistics to assess statistical significance.

Alcohol was not detected in any of the samples. Ethyl glucuronide, a specific alcohol metabolite, was found in 0.3% of the collected samples. Illicit drugs and medicinal drugs were identified in 0.6% and 7.3% of the samples, respectively. Both analytical results and self-reported use of alcohol and drugs during the past 12 months indicate that recent and past year alcohol and drug use was lower among HPs than among workers in other business areas in Norway, Europe and US. Nevertheless, several HPs reported absence from work due to alcohol (0.9%) and medicinal drug use (0.8%) during the past 12 months. A substantial part (16.7%) of the self-reported medicinal drug users reported absence from work because of use of medicinal drugs during the past 12 months, and more than 1/4 of those reported in-efficiency at work because of the use of medicinal drugs during the past 12 months. Reduced efficiency at work due to alcohol use during the past 12 months was reported by 12.2%.

This sample of HPs seldom used illicit drugs, few had a high level of alcohol consumption, and few tested positive for medicinal drugs. Absence or hangover related to the use of medicinal drugs or alcohol appeared to be a bigger issue than the acute intoxication or the use of illicit drugs.

Estimation of equivalent cutoff thresholds in blood and oral fluid for drug prevalence studies

Oral fluid is an easily available specimen for studying drug use in a cohort or population. The prevalence of drugs in samples of oral fluid is the same as the prevalence in blood if using equivalent cutoff concentrations. The cutoffs in oral fluid may be higher or lower than that in blood in accordance with the median oral fluid-to-blood (OF/B) concentration ratio, but it is also influenced by the skewness of the distribution of OF/B ratios. The aim of this study was to determine formulae for the estimation of equivalent cutoff concentrations in oral fluid and blood for 12 commonly used illegal and medicinal psychoactive drugs when oral fluid was collected with Statsure Saliva·Sampler™. Paired samples from 4,080 persons were collected and analyzed with chromatographic methods and mass spectroscopic detection. Regression formulae for the concentrations corresponding to selected percentiles in oral fluid versus the same concentration percentiles in blood were determined. The accuracy when multiplying the cutoff thresholds in blood with the average and median OF/B ratios to estimate equivalent cutoffs in oral fluid was also investigated. Prevalence regression gave the most accurate results. The regression formulae can be used to estimate equivalent cutoff concentrations in oral fluid and blood.

Current knowledge on cannabinoids in oral fluid

Oral fluid (OF) is a new biological matrix for clinical and forensic drug testing, offering non-invasive and directly observable sample collection reducing adulteration potential, ease of multiple sample collections, lower biohazard risk during collection, recent exposure identification, and stronger correlation with blood than urine concentrations. Because cannabinoids are usually the most prevalent analytes in illicit drug testing, application of OF drug testing requires sufficient scientific data to support sensitive and specific OF cannabinoid detection. This review presents current knowledge of OF cannabinoids, evaluating pharmacokinetic properties, detection windows, and correlation with other biological matrices and impairment from field applications and controlled drug administration studies. In addition, onsite screening technologies, confirmatory analytical methods, drug stability, and effects of sample collection procedure, adulterants, and passive environmental exposure are reviewed. Delta-9-tetrahydrocannabinol OF concentrations could be >1000 µg/L shortly after smoking, whereas minor cannabinoids are detected at 10-fold and metabolites at 1000-fold lower concentrations. OF research over the past decade demonstrated that appropriate interpretation of test results requires a comprehensive understanding of distinct elimination profiles and detection windows for different cannabinoids, which are influenced by administration route, dose, and drug use history. Thus, each drug testing program should establish cut-off criteria, collection/analysis procedures, and storage conditions tailored to its purposes. Building a scientific basis for OF testing is ongoing, with continuing OF cannabinoids research on passive environmental exposure, drug use history, donor physiological conditions, and oral cavity metabolism needed to better understand mechanisms of cannabinoid OF disposition and expand OF drug testing applicability. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Driving during alcohol hangover among dutch professional truck drivers

OBJECTIVES

Alcohol hangover may impair potentially dangerous daily activities such as driving a car or operating heavy machinery. The purpose of the present study was to determine (1) whether driving during alcohol hangover is a problem of concern among professional Dutch truck drivers and (2) to what extent they think their hangover state affects driving performance.

METHODS

Three hundred forty-three professional truck drivers were interviewed at a Dutch trucker festival. In addition to demographics, data were gathered on normal driving, alcohol consumption and hangover, and driving style during alcohol hangover.

RESULTS

More than half of the professional drivers who consume alcohol and report occasionally having a hangover (56.4%) acknowledge that they have driven while having a hangover during the past year: 26.5 percent only when driving private, 2.6 percent only when driving professionally, and 27.4 percent both private and professionally. Additionally, 45.3 percent reported driving while having a hangover sometimes, whereas 7.7 percent and 1.7 percent reported doing so often or always, respectively. During alcohol hangover, professional drivers rated their driving style as significantly less relaxed, less safe, and less responsible (P < .001).

CONCLUSIONS

Driving with a hangover is a common phenomenon, and professional drivers acknowledge that their driving is impaired. Therefore, future experimental research should examine the magnitude of impairment while driving with an alcohol hangover.

Ethyl glucuronide and ethyl sulfate

Alcohol misuse is associated with significant morbidity and mortality. Although clinical history, examination, and the use of self-report questionnaires may identify subjects with harmful patterns of alcohol use, denial or under-reporting of alcohol intake is common. Existing biomarkers for detecting alcohol misuse include measurement of blood or urine ethanol for acute alcohol consumption, and carbohydrate-deficient transferrin and gamma-glutamyl transferase for chronic alcohol misuse. There is a need for a biomarker that can detect excessive alcohol consumption in the timeframe between 1 day and several weeks. Ethyl glucuronide (EtG) is a direct metabolite of ethanol detectable in urine for up to 90 h and longer in hair. Because EtG has high specificity for excess alcohol intake, it has great potential for use in detecting "binge" drinking. Using urine or hair, this noninvasive marker has a role in a variety of clinical and forensic settings.

A Norwegian study of the suitability of hair samples in epidemiological research of alcohol, nicotine and drug use

A feasibility study was performed to examine the effectiveness of hair testing in determining the prevalence of drug use in a young adult population. The study included 200 randomly selected young adults in Norway. It was designed to make the collection, preparation and analysis of the samples as little resource demaning as possible. Full anonymity was provided for the participants. In total, 23.5% of the samples were positive for one or more substances (14.5%, excluding the nicotine metabolite cotinine). Of the samples, 5% were positive for at least one illegal drug, 9.5% for a medicinal drug, 11.5% for cotinine and 2.5% for the alcohol metabolite ethyl glucuronide. The preliminary findings suggest that the study protocol used to collect and analyze the samples was unable to produce results that could be generalized to the young adult population in Norway. Analysis of hair samples may underestimate the use of cannabis, alcohol, amphetamine and methamphetamine. It may, however, be done to estimate cocaine and general drug use if a sample-collection procedure different from that described in our study is used and includes information about hair length, sample length, length from the scalp, cosmetic treatment, washing and whether the samples always get washed/decontaminated prior to analysis.

Measurement of alcohol hangover severity: development of the Alcohol Hangover Severity Scale (AHSS)

OBJECTIVE

This study aims to develop a new alcohol hangover symptom severity scale and compare its effectiveness with the Hangover Symptoms Scale (HSS), the Acute Hangover Scale (AHS), and a one-item hangover score.

METHODS

Data from 1,410 Dutch students (Penning et al., Alcohol Alcohol 47:248-252, 2012) on the severity of 47 hangover symptoms were re-analyzed to develop the Alcohol Hangover Severity Scale (AHSS). The psychometric properties of the AHSS were compared with those of the HSS and the AHS. A survey among 1,000 students compared the AHSS and HSS with a one-item hangover severity score. The AHSS was further tested in a naturalistic hangover experiment.

RESULTS

The 12 items of the AHSS were fatigue, clumsiness, dizziness, apathy, sweating, shivering, nausea, heart pounding, confusion, stomach pain, concentration problems, and thirst. The Penning et al. (Alcohol Alcohol 47:248-252, 2012) data revealed that the predictive validity of the AHSS (92.4 %) for the overall hangover score was significantly higher than that of the HSS (81.5 %) and the AHS (71.0 %). The survey data (N = 966) showed that scores on the AHSS (39.7 %) and the HSS (47.6 %) only moderately predicted the one-item hangover score. A total of 119 subjects completed the naturalistic study. On average, they consumed 9.7 alcoholic consumptions, yielding a mean estimated blood alcohol concentration (BAC) of 0.16 %. During hangover, the AHSS score correlated significantly with the number of alcoholic consumptions (r = 0.38, p < 0.0001) and estimated BAC (r = 0.40, p < 0.0001).

CONCLUSIONS

The AHS, HSS, and AHSS all seem appropriate for application in hangover research. The use of a one-item hangover scale is not recommended.

Consumer satisfaction and efficacy of the hangover cure after-effect(©)

A consumer satisfaction study was conducted to examine the effectiveness on hangover of After-Effect^©, a new food supplement dedicated to improve well-being after an occasion of alcohol consumption. N = 113 persons were invited to participate in a home-based open label study to test the effectiveness of After-Effect^©. On a night when they intended to consume alcohol, three pills were taken before alcohol consumption and two pills afterwards, before going to bed. The following day, participants completed a survey on the amount of alcohol consumed, hangover symptom severity, and satisfaction of the product. N = 103 participants completed the study. 88% of participants reported After-Effect^© to be effective in reducing alcohol hangover. After-Effect^© significantly improved overall hangover severity, and all individual hangover symptoms, except for palpitations. In addition, a significant reduction (P = 0.0001) in the severity score on concentration problems was reported when using After-Effect^©. No gender differences were observed, and there was no relationship with the number of alcoholic drinks that were consumed. Consumers were satisfied with the product. In conclusion, consumer satisfaction and hangover severity scores suggest that After-Effect^© may be effective in reducing alcohol hangover. However, controlled, double-blind clinical trials should confirm these findings.

Ethyl glucuronide

Alcohol is associated with significant morbidity and mortality. Subjects abusing alcohol can be identified through clinical history, examination or self-report questionnaires. A range of biomarkers is available for detecting alcohol misuse, but there is still a need for a marker that can detect alcohol consumption in the time window between one day (ethanol) and one week (gamma-glutamyl transpeptidase and carbohydrate-deficient transferrin). Ethyl glucuronide is a direct metabolite that can be detected in urine for up to 90 h and has the potential to become a useful marker of 'binge' drinking. As a non-invasive marker, it could have a role in a variety of clinical and forensic settings.

The alcohol hangover research group consensus statement on best practice in alcohol hangover research

Alcohol-induced hangover, defined by a series of symptoms, is the most commonly reported consequence of excessive alcohol consumption. Alcohol hangovers contribute to workplace absenteeism, impaired job performance, reduced productivity, poor academic achievement, and may compromise potentially dangerous daily activities such as driving a car or operating heavy machinery. These socioeconomic consequences and health risks of alcohol hangover are much higher when compared to various common diseases and other health risk factors. Nevertheless, unlike alcohol intoxication the hangover has received very little scientific attention and studies have often yielded inconclusive results. Systematic research is important to increase our knowledge on alcohol hangover and its consequences. This consensus paper of the Alcohol Hangover Research Group discusses methodological issues that should be taken into account when performing future alcohol hangover research. Future research should aim to (1) further determine the pathology of alcohol hangover, (2) examine the role of genetics, (3) determine the economic costs of alcohol hangover, (4) examine sex and age differences, (5) develop common research tools and methodologies to study hangover effects, (6) focus on factor that aggravate hangover severity (e.g., congeners), and (7) develop effective hangover remedies.