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Verster JC, van de Loo AJ, Benson S, Scholey A, Stock AK. The Assessment of Overall Hangover Severity. J Clin Med 2020; 9:jcm9030786. [PMID: 32183161 PMCID: PMC7141364 DOI: 10.3390/jcm9030786] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to critically evaluate and compare the different methods to assess overall hangover severity. Currently, there are three multi-item hangover scales that are commonly used for this purpose. All of them comprise a number of hangover symptoms for which an average score is calculated. These scales were compared to a single, 1-item scale assessing overall hangover severity. The results showed that the hangover symptom scales significantly underestimate (subjective) hangover severity, as assessed with a 1-item overall hangover severity scale. A possible reason for this could be that overall hangover severity varies, depending on the frequency of occurrence of individual symptoms included in the respective scale. In contrast, it can be assumed that, when completing a 1-item overall hangover scale, the rating includes all possible hangover symptoms and their impact on cognitive and physical functioning and mood, thus better reflecting the actually experienced hangover severity. On the other hand, solely relying on hangover symptom scales may yield false positives in subjects who report not having a hangover. When the average symptom score is greater than zero, this may lead to non-hungover subjects being categorized as having a hangover, as many of the somatic and psychological hangover symptoms may also be experienced without consuming alcohol (e.g., having a headache). Taken together, the current analyses suggest that a 1-item overall hangover score is superior to hangover symptom scales in accurately assessing overall hangover severity. We therefore recommend using a 1-item overall hangover rating as primary endpoint in future hangover studies that aim to assess overall hangover severity.
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Affiliation(s)
- Joris C Verster
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (A.J.A.E.v.d.L.)
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584CM Utrecht, The Netherlands
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia; (S.B.) (A.S.)
| | - Aurora J.A.E. van de Loo
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (A.J.A.E.v.d.L.)
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584CM Utrecht, The Netherlands
| | - Sarah Benson
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia; (S.B.) (A.S.)
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia; (S.B.) (A.S.)
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
- Correspondence:
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Verster JC, Kruisselbrink LD, Slot KA, Anogeianaki A, Adams S, Alford C, Arnoldy L, Ayre E, Balikji S, Benson S, Bruce G, Devenney LE, Frone MR, Gunn C, Heffernan T, Hensel KO, Hogewoning A, Johnson SJ, van Lawick van Pabst AE, van de Loo AJ, Mackus M, Merlo A, Murphy RJ, Owen L, Palmer EO, van Rossum CJ, Scholey A, Terpstra C, Vatsalya V, Vermeulen SA, van Wijk M, Stock AK. Sensitivity to Experiencing Alcohol Hangovers: Reconsideration of the 0.11% Blood Alcohol Concentration (BAC) Threshold for Having a Hangover. J Clin Med 2020; 9:E179. [PMID: 31936502 PMCID: PMC7019760 DOI: 10.3390/jcm9010179] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 01/12/2023] Open
Abstract
The 2010 Alcohol Hangover Research Group consensus paper defined a cutoff blood alcohol concentration (BAC) of 0.11% as a toxicological threshold indicating that sufficient alcohol had been consumed to develop a hangover. The cutoff was based on previous research and applied mostly in studies comprising student samples. Previously, we showed that sensitivity to hangovers depends on (estimated) BAC during acute intoxication, with a greater percentage of drinkers reporting hangovers at higher BAC levels. However, a substantial number of participants also reported hangovers at comparatively lower BAC levels. This calls the suitability of the 0.11% threshold into question. Recent research has shown that subjective intoxication, i.e., the level of severity of reported drunkenness, and not BAC, is the most important determinant of hangover severity. Non-student samples often have a much lower alcohol intake compared to student samples, and overall BACs often remain below 0.11%. Despite these lower BACs, many non-student participants report having a hangover, especially when their subjective intoxication levels are high. This may be the case when alcohol consumption on the drinking occasion that results in a hangover significantly exceeds their "normal" drinking level, irrespective of whether they meet the 0.11% threshold in any of these conditions. Whereas consumers may have relative tolerance to the adverse effects at their "regular" drinking level, considerably higher alcohol intake-irrespective of the absolute amount-may consequentially result in a next-day hangover. Taken together, these findings suggest that the 0.11% threshold value as a criterion for having a hangover should be abandoned.
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Affiliation(s)
- Joris C. Verster
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584CM Utrecht, The Netherlands
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia; (E.A.); (S.B.); (A.S.); (C.T.)
| | - L. Darren Kruisselbrink
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS B4P 2R6, Canada; (L.D.K.)
| | - Karin A. Slot
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Aikaterini Anogeianaki
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Sally Adams
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath BA2 7AY, UK; (S.A.); (C.G.)
| | - Chris Alford
- Psychological Sciences Research Group, University of the West of England, Bristol BS16 1QY, UK; (C.A.); (S.J.J.)
| | - Lizanne Arnoldy
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Elisabeth Ayre
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia; (E.A.); (S.B.); (A.S.); (C.T.)
| | - Stephanie Balikji
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Sarah Benson
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia; (E.A.); (S.B.); (A.S.); (C.T.)
| | - Gillian Bruce
- Education and Social Sciences, University of the West of Scotland, Paisley PA1 2BE, UK; (G.B.); (A.M.)
| | - Lydia E. Devenney
- School of Psychology, Life and Health Sciences, Ulster University, Coleraine, Co. Londonderry BT52 1SA, UK;
| | - Michael R. Frone
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA;
| | - Craig Gunn
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath BA2 7AY, UK; (S.A.); (C.G.)
| | - Thomas Heffernan
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Kai O. Hensel
- Cambridge Biomedical Campus, Department of Paediatrics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
- Faculty of Health, Department of Paediatrics, Center for Clinical & Translational Research (CCTR), Witten/Herdecke University, 58455 Witten, Germany
| | - Anna Hogewoning
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Sean J. Johnson
- Psychological Sciences Research Group, University of the West of England, Bristol BS16 1QY, UK; (C.A.); (S.J.J.)
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK
| | - Albertine E. van Lawick van Pabst
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Aurora J.A.E. van de Loo
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Marlou Mackus
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Agnese Merlo
- Education and Social Sciences, University of the West of Scotland, Paisley PA1 2BE, UK; (G.B.); (A.M.)
| | - René J.L. Murphy
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS B4P 2R6, Canada; (L.D.K.)
| | - Lauren Owen
- Department of Psychology, School of Health and Society, University of Salford, Salford 5 M6 6PU, UK;
| | - Emily O.C. Palmer
- Department of Medicine, Imperial College London, London W12 0NN, UK;
| | - Charmaine J.I. van Rossum
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia; (E.A.); (S.B.); (A.S.); (C.T.)
| | - Chantal Terpstra
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia; (E.A.); (S.B.); (A.S.); (C.T.)
| | - Vatsalya Vatsalya
- Department of Medicine, University of Louisville, Louisville, KY 40202, USA;
- Alcohol Research Center, University of Louisville, Louisville, KY 40202, USA
- Hepatobiology & Toxicology Center, University of Louisville, Louisville, KY 40202, USA
- National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD 20892, USA
- Robley Rex Louisville VAMC, Louisville, KY 40206, USA
| | - Sterre A. Vermeulen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Michelle van Wijk
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands; (J.C.V.); (K.A.S.); (A.A.); (L.A.); (S.B.); (A.H.); (A.E.v.L.v.P.); (M.M.); (S.A.V.); (M.v.W.)
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, University of Dresden, D-01307 Dresden, Germany
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