The Pathology of Alcohol Hangover

Investigating the effects of emotion dysregulation and repetitive negative thinking on alcohol hangover anxiety and depression

INTRODUCTION

Underlying factors associated with alcohol hangover psychological symptoms, such as anxiety and depression, have not been identified. Emotion dysregulation and repetitive negative thinking (RNT) are transdiagnostic factors associated with psychopathology, including non-hangover anxiety and depression. The current study prospectively examined the role of emotion dysregulation on subsequent alcohol hangover anxiety and depression symptoms, as well as the moderating role of RNT on this relation among university students.

METHODS

One hundred thirty-six participants completed baseline assessments of emotion dysregulation (DERS-16) and non-hangover anxiety and depression (DASS-21). Thirty-nine participants reported experiencing alcohol hangover at 2-week follow up and completed assessments of RNT (PTQ) and hangover anxiety and depression (modified DASS-21). Two independent regression-based moderation analyses were conducted to examine the relation of baseline emotion dysregulation, 2-week follow-up RNT, and hangover anxiety and depression symptoms after accounting for baseline non-hangover anxiety and depression symptoms.

RESULTS

Among those experiencing alcohol hangover (n = 39), emotion dysregulation and RNT were not associated with hangover related anxiety beyond non-hangover anxiety. Emotion dysregulation significantly predicted hangover depression but was rendered non-significant by the addition of RNT, which was significantly associated with hangover depression. RNT moderated the emotion dysregulation-hangover depression relation such that emotion dysregulation was not associated with future hangover depression at low levels of RNT but was positively associated with hangover depression at moderate to high levels of RNT.

CONCLUSION

Results provide preliminary support for the role of emotion dysregulation and RNT in hangover depression severity.

Depression, Anxiety, and Stress among Hangover-Sensitive and Hangover-Resistant Drinkers

This study investigated potential differences in baseline (i.e., non-hangover-related) levels of depression, anxiety, and stress between individuals who are sensitive to and those resistant to hangovers after consuming alcohol. Participants included 5111 university students from the Netherlands and the U.K., including 3205 hangover-sensitive and 1906 hangover-resistant drinkers. All participants completed surveys on their demographics, alcohol consumption, and hangover susceptibility (whether they experienced a hangover in the past 12 months), as well as their baseline levels of depression, anxiety, and stress on the DASS-21 scale. The results showed that hangover-sensitive drinkers had significantly higher levels of anxiety and stress, but not depression, compared to hangover-resistant drinkers. However, the observed differences between the two groups were small, with a magnitude of less than 1 out of 42 points on the DASS-21 anxiety and stress subscales, and are thus unlikely to be clinically meaningful.

Differences in Next-Day Adverse Effects and Impact on Mood of an Evening of Heavy Alcohol Consumption between Hangover-Sensitive Drinkers and Hangover-Resistant Drinkers

The combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero, are collectively referred to as the alcohol hangover. Previous research revealed that 10 to 20% of drinkers claim not to experience next-day hangovers. Past studies were usually limited to single timepoint assessments. The aim of the current semi-naturalistic study was to compare the next-day effects of an evening of alcohol consumption of self-reported hangover-resistant drinkers (n = 14) with those of a group of self-reported hangover-sensitive drinkers (n = 15) at hourly timepoint throughout the day (09:30 until 15:30). Assessments of 23 hangover symptoms, mood (Profiles of Mood States-Short Form), and daytime sleepiness (Karolinska Sleepiness Scale) were made hourly after both an alcohol day and an alcohol-free control day. Additional morning assessments were made for mood (State-Trait Anxiety Inventory-Y, Beck’s Depression Inventory-II), risk-taking behavior (RT-18), past night sleep (Groningen Sleep Quality Scale), alcohol consumption, and activities during the test days. No significant differences were found regarding the amount of alcohol consumed and the total sleep time of the two groups. The hangover-sensitive group reported having a hangover as well as the presence of a variety of hangover-related symptoms, which were most severe in the morning and then gradually decreased during the day. The most frequently reported and most severe symptoms were sleepiness and fatigue, concentration problems, and headache. In contrast, the hangover-resistant group reported the absence of a hangover and the presence and severity of next-day symptoms did not significantly differ from the control day, except for increased fatigue and reduced vigor. The next-day effects on sleepiness-related complaints and vigor were significantly more pronounced among hangover-sensitive drinkers compared to hangover-resistant drinkers. In conclusion, contrary to hangover-resistant drinkers, hangover-sensitive drinkers report a variety of hangover symptoms that gradually ease during the day, but are still present in the afternoon.

Noni fruit extract ameliorates alcohol-induced hangover symptoms by reducing the concentrations of alcohol and acetaldehyde in a Sprague Dawley rat model and a human intervention study

Various studies have reported that Noni shows various health effects. This study aimed to assess the ability of Noni fruit extract to serve as a single active functional ingredient for the alleviation of hangover symptoms in Sprague Dawley rats and healthy subjects in a single-dose, randomized, double-blind, crossover, placebo-controlled study. The rats were orally administered Noni fruit extract at 50 or 100 mg per kg body weight (B.W.) and HOVENIA. The blood ethanol (EtOH) and acetaldehyde concentrations were significantly lower in the 100 mg per kg B.W. group than in the EtOH group. Alcohol dehydrogenase and aldehyde dehydrogenase activity tended to increase in the 100 mg kg^-1 B.W. group. In the human study, 30 subjects received either a placebo or Noni fruit extract (1 g). The Noni fruit extract group showed significantly faster time point at which the maximum concentration (T_max) of alcohol than in the placebo group. In addition, blood acetaldehyde levels and diarrhea at 40 and 720 min after alcohol intake and the area under the curve between 40 and 60 min of acetaldehyde were significantly decreased in the Noni fruit extract group compared to the placebo group. According to the QUalitative INteraction Trees, subjects who were ≤36 years old who consumed more alcohol (>15 drinks per week) and had a higher total hangover score (>27.5 and 33) presented significantly lower blood acetaldehyde levels and less severe hangover symptoms. These results indicate that Noni fruit extract has the potential to improve hangover symptoms by decreasing alcohol and acetaldehyde levels.

Evaluating and forecasting the associated main flavor components in Baijiu (Chinese distilled spirits) with alcohol metabolism and hangover symptoms through mice acute withdrawal model

Over the past few decades, more alcohol-problem concerns focused on reducing the risk of hangover caused by the alcoholic beverages over-consumption. Chinese distilled spirits (Baijiu) is one of the most favorite alcoholic beverages. The intention of this study is to explore the associations of main flavor components in Baijiu and hangover symptoms using mice acute alcohol withdrawal model. The behaviors of each mouse were assessed by open-field tests using separate groups of mice with the treatment of sauce-aroma Baijiu, light-aroma Baijiu, strong-aroma Baijiu, pure alcohol, and distilled water, respectively. The behavioral data including total move distance and immobile time were used as indicators for the evaluation of the liquor intoxicating effects. Alcohol and acetaldehyde concentrations in mice plasma and the neurotransmitter contents of GABA and Glu in mice cerebellum were detected afterward. The results showed that the mice with the treatment of Baijiu samples displayed unusual exciting behaviors including increased alcohol metabolization with alleviating drunken and hangover symptoms, compared with that of pure alcohol control groups after 2-4 h. Moreover, the sauce-aroma Baijiu treatment group showed lessening intoxicated symptoms than those of light-aroma Baijiu and strong-aroma Baijiu. In addition, there were significant differences between Baijiu and pure alcohol treatment groups at the inhibitory neurotransmitter GABAergic levels and its receptor GABA-AR1 activating levels in the mice neuron cells. Furthermore, the Principal Component Analysis (PCA) analysis inferred that the flavor compounds acetic acid, ethyl acetate, ethyl lactate, and 1-propanol in the sauce-aroma Baijiu were played the major roles in the drunk behaviors that caused by the hangover. While, the acetic acid in the sauce-aroma Baijiu was speculated as a major flavor component to accelerate the alcohol metabolism and retard hangover symptoms.

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.

Hydrogen Intake Relieves Alcohol Consumption and Hangover Symptoms in Healthy Adults: a Randomized and Placebo-Controlled Crossover Study

BACKGROUND

Alcohol-induced hangover represents a significant, yet understudied, global hazard and a large socio-economic burden.

OBJECTIVES

The aim of this study was to investigate the effects of hydrogen (H2) on relieving drinking and hangover symptoms in 20 healthy volunteers.

METHODS

In this pilot, randomized, double-blinded, placebo-controlled, matched, crossover interventional trial, participants were matched into pairs and randomly assigned. Study group 1 inhaled placebo air for 1 hr, followed by drinking 100 ml of liquor (40% alcohol) within 10 min, and then pure water. Study group 2 inhaled a mixture of H2 and O2 gas for 1 hr, followed by drinking 100 ml of liquor within 10 min, and then H2 dissolved in water. On a second intervention day (crossover) ≥1 wk later, study-group subjects were switched to the opposite order. Breath alcohol concentration (BrAC), hangover severity, and cognitive scores were measured.

RESULTS

The BrACs within the H2 group were significantly lower than those within the placebo group after 30 min, 60 min, and 90 min (P < 0.05). The H2 group reported having fewer hangover symptoms compared with the placebo group (Placebo: 77% of symptoms absent, 19.7% of mild symptoms, 2.7% of moderate symptoms, 0.7% of severe symptoms; H2: 88.6% of symptoms absent, 10% of mild symptoms, 1.3% of moderate symptoms, 0% of severe symptoms; P < 0.001). H2 treatment improved cognitive testing scores (P < 0.05), including attention and executive functions. Furthermore, consumption of H2 was negatively (β = -13.016; 95% CI: -17.726, -8.305; P < 0.001) and female sex was positively (β = 22.611; 95% CI: 16.226, 28.997; P < 0.001) correlated with increased BrACs. Likewise, the consumption of H2 was negatively (OR: 0.035; 95% CI: 0.007, 0.168; P < 0.001) while female sex was positively (OR: 28.838; 95% CI: 5.961, 139.506; P < 0.001) correlated with the severity of hangover symptoms.

CONCLUSIONS

H2 decreases BrACs and relieves the symptoms of hangovers.This trial was registered at China Clinical Trial Registry as ChiCTR2200059988. URL of registration: http://www.chictr.org.cn/showproj.aspx?proj=58359.

The Relationship between Alcohol Hangover Severity, Sleep and Cognitive Performance; a Naturalistic Study

Alcohol hangover (AH) has been associated with poor sleep due to the negative effects of alcohol intoxication on sleep quantity and sleep quality. The aim of the current study was to further explore the relationship between AH severity and sleep using a naturalistic study design. A further aim was to determine whether quantitative aspects of sleep were a mediating influence on the relationship between AH severity and cognitive performance. As part of the naturalistic study design, 99 drinkers were recruited following a night of drinking in an Australian state capital, with breath alcohol concentration (BrAC) measured as participants were leaving the entertainment district. The following morning at home, participants answered online questions regarding their drinking behaviour on the previous evening, current AH symptoms and sleep quality. Participants also completed an online version of the Trail-Making Test B (TMT-B) to assess cognitive performance. The findings reveal the duration of nightly awakenings to be negatively related to six individual AH symptoms as well as overall AH severity. The number of nightly awakenings, sleep quality and total sleep time correlated with four AH symptoms including overall AH severity. Total AH severity accounted for a moderate amount of variance (11%) in the time to complete the TMT-B. These findings confirm that alcohol consumption negatively affects sleep, which is related to higher next-day hangover severity ratings and poorer cognitive performance.

The 5HTOL/5HIAA Ratio as a Biomarker of Alcohol Hangover

Assessment of the presence and severity of alcohol hangovers relies on the subjective method of self-report. Therefore, there is a need of adequate biomarkers that (1) correlate significantly with hangover severity, and (2) correspond to the level of hangover-related performance impairment objectively. In this naturalistic study, n = 35 social drinkers participated. Urine samples were obtained the morning after alcohol consumption and after an alcohol-free control day. Concentrations of 5-hydroxytryptophol (5-HTOL), 5-hydroxyindoleacetic acid (5-HIAA) and the 5-HTOL/5-HIAA ratio were determined. The results confirm previous findings that 5-HTOL and the 5HTOL/5-HIAA ratio are useful biomarkers of recent alcohol consumption. Significant correlations were found with the amount of alcohol consumed, total drink time, and estimated BAC. However, urine concentrations of 5-HTOL and 5-HIAA (and their ratio 5HTOL/5-HIAA) did not significantly correlate with hangover severity. In conclusion, urine 5-HTOL, 5-HIAA, and the 5HTOL/5-HIAA ratio cannot be considered to be suitable biomarkers of alcohol hangover.

The use of N-acetylcysteine in the prevention of hangover: a randomized trial

Hangovers resulting from alcohol intoxication can lead to adverse effects ranging from generalized discomfort and work-related absenteeism to emergency department visits from patients seeking symptomatic care. The purpose of this study was to evaluate the efficacy of a low dose (600–1800 mg) of N-Acetylcysteine (NAC) vs placebo on mitigating hangover symptoms. This was a randomized, double-blinded, placebo controlled crossover study involving 49 volunteers who consumed beer to obtain a breath alcohol content (BrAC) of 0.1 g/210L. The participants met on two separate occasions at which time they were given either NAC or placebo capsules. Opposing treatments were administered during the second encounter. The morning after the participant’s intoxication and treatment, a Hangover Symptom Scale Questionnaire was administered to determine subjective changes in hangover symptoms. Data was analyzed by self-control, comparing the participant’s hangover symptom severity when using NAC compared to placebo. No significant difference was found in the general distribution of total hangover scores (P = .45) (NAC = 10; Placebo = 13). There was also no significant difference found in the general distribution of specific hangover symptoms. However, a significant difference was found in the general distribution of total hangover difference scores based on gender (P = .04) (Female − 3.5; Male 2), specifically for nausea (P = .05) and weakness (P = .03). Although no difference was found in the general hangover scale scores, the study was suggestive of gender specific susceptibility with female participants having improved hangover symptoms after NAC use.

Immune Responses after Heavy Alcohol Consumption: Cytokine Concentrations in Hangover-Sensitive and Hangover-Resistant Drinkers

This study investigated immunological changes during an alcohol hangover, and the possible difference between hangover-resistant and hangover-sensitive drinkers in terms of immune reactivity. Using a semi-naturalistic design, N = 36 healthy social drinkers (18 to 30 years old) provided saliva samples on a control day (after drinking no alcohol) and on a post-alcohol day. Hangover severity was rated directly after saliva collection. Cytokine concentrations, interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α, and hangover severity were compared between both test days and between hangover-sensitive and -resistant drinkers. Data from N = 35 drinkers (17 hangover-sensitive and 18 hangover-resistant) were included in the statistical analyses. Relative to the control day, there were significant increases in saliva IL-6 and IL-10 concentrations on the post-alcohol day. No significant differences in cytokine concentrations were found between hangover-sensitive and hangover-resistant drinkers, nor did any change in cytokine concentration correlate significantly with hangover severity. In line with previous controlled studies assessing cytokines in blood, the current naturalistic study using saliva samples also demonstrated that the immune system responds to high-level alcohol intake. However, further research is warranted, as, in contrast to previous findings in blood samples, changes in saliva cytokine concentrations did not differ significantly between hangover-sensitive and hangover-resistant drinkers, nor did they correlate significantly with hangover severity.

The Relationship between Pain Sensitivity, Pain Catastrophizing and Hangover Severity

Recent research found a significant and positive correlation between hangover severity and pain catastrophizing. The current study aimed to verify these findings. Data from N = 673 subjects with a mean (SD) age of 42.2 (19.1) years old (range: 18 to 87 years old) was evaluated. An online survey collected data on alcohol consumption and hangovers related to their heaviest drinking occasion between 15 January and 14 March 2020. When correcting for the amount of alcohol consumed, significant correlations were found between hangover severity and both sensitivity to pain (r = 0.085, p = 0.029) and pain catastrophizing (r = 0.095, p = 0.015). In addition, subjective intoxication correlated significantly with sensitivity to pain (r = 0.080, p = 0.041) and pain catastrophizing (r = 0.099, p = 0.011). Overall, the results were more pronounced in men than women, and the associations with pain catastrophizing were strongest for the subscale assessing rumination. In conclusion, although statistically significant, the observed correlations were of small magnitude. Nevertheless, the observations confirm previous findings that suggest a link between pain perception, alcohol consumption, and hangover severity, which warrants further investigation.

Randomised double-blind placebo-controlled intervention study on the nutritional efficacy of a food for special medical purposes (FSMP) and a dietary supplement in reducing the symptoms of veisalgia

Objective

To assess whether the symptoms of veisalgia can be reduced by intense water supply and the intake of antioxidative supplements and plant extracts.

Methods

We performed the world’s largest randomised double-blind placebo-controlled intervention study (214 participants) on the efficacy of a food for special medical purposes (FSMP) against veisalgia symptoms. We analysed the effectiveness of: (1) an FSMP, including distinct plant extracts, vitamins and minerals, and additional (antioxidative) compounds; (2) a dietary supplement only comprising vitamins and minerals and additional (antioxidative) compounds; and (3) a placebo containing only glucose. The study followed the CONSORT (Consolidated Standards of Reporting Trials) guidelines and trial registration was not necessary.

Results

Our study showed no statistically significant relationship between the variation of body water content and alcohol consumption. Contrary to common belief, the results showed that intervention with a supplement containing vitamins and minerals and additional antioxidative compounds did not lead to a statistically significant improvement in hangover symptoms. Additionally, our results confirmed a high individual variability in developing hangover symptoms depending on the amount of alcohol. Thus, standardisation of the amount of alcohol consumed in hangover studies does not necessarily contribute to the validity of the results. Finally, this study found a number of positive effects on certain hangover symptoms as a result of the FSMP, which were most likely due to the plant extracts contained within the food.

Conclusion

This study significantly supports the finding that haemostasis of electrolytes and minerals caused by alcohol consumption might be negligible and that no significant dehydration due to alcohol consumption seems to occur. Additionally, only the FSMP provides evidence for a significant efficiency in the reduction of hangover symptoms such as headache and nausea following moderate and non-excessive alcohol consumption.

The Alcohol Hangover Research Group: Ten Years of Progress in Research on the Causes, Consequences, and Treatment of the Alcohol Hangover

The alcohol hangover is defined as the combination of negative mental and physical symptoms, which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero. Here, we present the book "The alcohol hangover: causes, consequences, and treatment", written to celebrate the 10th anniversary of the Alcohol Hangover Research Group (AHRG), summarizing recent advances in the field of alcohol hangover research.

The Role of Alcohol Metabolism in the Pathology of Alcohol Hangover

The limited number of available studies that examined the pathology of alcohol hangover focused on biomarkers of alcohol metabolism, oxidative stress and the inflammatory response to alcohol as potentially important determinants of hangover severity. The available literature on alcohol metabolism and oxidative stress is reviewed in this article. The current body of evidence suggests a direct relationship between blood ethanol concentration and hangover severity, whereas this association is not significant for acetaldehyde. The rate of alcohol metabolism seems to be an important determinant of hangover severity. That is, fast elimination of ethanol is associated with experiencing less severe hangovers. An explanation for this observation may be the fact that ethanol-in contrast to acetaldehyde-is capable of crossing the blood-brain barrier. With slower ethanol metabolism, more ethanol is able to reach the brain and elicit hangover symptoms. Hangover severity was also significantly associated with biomarkers of oxidative stress. More oxidative stress in the first hours after alcohol consumption was associated with less severe next-day hangovers (i.e., a significant negative correlation was found between hangover severity and malondialdehyde). On the contrary, more oxidative stress at a later stage after alcohol consumption was associated with having more severe next-day hangovers (i.e., a significant positive correlation was found between hangover severity and 8-isoprostane). In conclusion, assessment of biomarkers of alcohol metabolism suggests that fast elimination of ethanol is associated with experiencing less severe hangovers. More research is needed to further examine the complex interrelationship between alcohol metabolism, the role of acetaldehyde and oxidative stress and antioxidants, and the pathology of the alcohol hangover.

Twenty-first birthday drinking: Extreme-drinking episodes and white matter microstructural changes in the fornix and corpus callosum

The 21st birthday celebration is characterized by extreme alcohol consumption. Accumulating evidence suggests that high-dose bingeing is related to structural brain changes and cognitive deficits. This is particularly problematic in the transition from adolescence to adulthood when the brain is still maturing, elevating the brain's sensitivity to the acute effects of alcohol intoxication. Heavy drinking is associated with reduced structural integrity in the hippocampus and corpus callosum and is accompanied by cognitive deficits. However, there is little research examining changes in the human brain related to discrete heavy-drinking episodes. The present study investigated whether alcohol exposure during a 21st birthday celebration would result in changes to white matter microstructure by utilizing diffusion tensor imaging measures and a quasi-experimental design. By examining structural changes in the brain from pre- to postcelebration within subjects (N = 49) prospectively, we were able to more directly observe brain changes following an extreme-drinking episode. Region of interest analyses demonstrated increased fractional anisotropy in the posterior fornix (p < .0001) and in the body of the corpus callosum (p = .0029) from pre- to postbirthday celebration. These results suggest acute white matter damage to the fornix and corpus callosum following an extreme-drinking episode, which is especially problematic during continued neurodevelopment. Therefore, 21st birthday drinking may be considered an important target event for preventing acute brain injury in young adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

University Students' Hangover May Affect Cognitive Research

University students are the most employed category of participants in cognitive research. However, researchers cannot fully control what their participants do the night before the experiments (e.g., consumption of alcohol) and, unless the experiment specifically concerns the effects of alcohol consumption, they often do not ask about it. Despite previous studies demonstrating that alcohol consumption leads to decrements in next-day cognitive abilities, the potential confounding effect of hangover on the validity of cognitive research has never been addressed. To address this issue, in the present study, a test-retest design was used, with two groups of university students: at T0, one group was constituted by hungover participants, while the other group was constituted by non-hungover participants; at T1, both groups were re-tested in a non-hangover state. In particular, the tests used were two versions of a parity judgment task and an arithmetic verification task. The results highlight that: (a) the response times of university students experiencing a hangover are significantly slower than those of non-hangover students and (b) the response times of hungover students are slower than those of the same students when re-tested in a non-hangover state. Additionally, it was also observed that the prevalence of hungover students in the university campus varies depending on the day of the week, with a greater chance of enrolling hungover participants on specific days. In light of the latter result, the recruitment of university students as participants in cognitive experiments might lead researchers to erroneously attribute their results to the variables they are manipulating, ignoring the effects of the potential hangover state.

Prevalence of Hangover Resistance According to Two Methods for Calculating Estimated Blood Alcohol Concentration (eBAC)

Hangover resistance may be linked to an increased risk of continuing harmful drinking behaviours as well as involvement in potentially dangerous daily activities such as driving while hungover, mainly due to the absence of negative consequences (i.e., hangover symptoms) the day after alcohol consumption. The aim of this study was to examine the occurrence of claimed alcohol hangover resistance relative to estimated blood alcohol concentration (eBAC). A total of 1198 participants completed an online survey by answering questions regarding their demographics, alcohol consumption and occurrence of hangover. Two methods were used to calculate eBAC, one based on the modified Widmark Equation (N = 955) and the other from an equation averaging the total body water (TBW) estimates of Forrest, Watson, Seidl, Widmark and Ulrich (males only) (N = 942). The percentage of participants who claimed to be hangover resistant decreased rapidly with increasing eBAC and only a small number of hangover resistant drinkers remained at higher eBACs. Comparisons of the eBACs calculated by the two methods revealed significantly higher BACs when using the modified Widmark equation. These findings suggest that additional research for eBAC calculations is needed to improve accuracy and comprehensiveness of these equations for future alcohol hangover research.

Effects of Rapid Recovery on Alcohol Hangover Severity: A Double-Blind, Placebo-Controlled, Randomized, Balanced Crossover Trial

The aim of this study was to evaluate the efficacy of putative hangover treatment, Rapid Recovery, in mitigating alcohol hangover (AH) symptom severity. Using a double-blind, randomized, placebo-controlled, balanced crossover design, 20 participants attended the laboratory for two evenings of alcohol consumption, each followed by morning assessments of AH severity. Participants were administered Rapid Recovery and placebo on separate visits. In the first testing visit, participants self-administered alcoholic beverages of their choice, to a maximum of 1.3 g/kg alcohol. Drinking patterns were recorded and replicated in the second evening testing visit. In the morning visits, AH severity was assessed using questionnaires measuring AH symptom severity and sleep quality, computerized assessments of cognitive functioning as well as levels of blood biomarkers of liver function (gamma-glutamyl transferase (GGT)) and inflammation (high-sensitive C-reactive protein (hs-CRP)). There were no differences in the blood alcohol concentrations (BAC) obtained in the Rapid Recovery (mean = 0.096%) and placebo (mean = 0.097%) conditions. Participants reported significantly greater sleep problems in the Rapid Recovery compared to placebo condition, although this difference was no longer significant following Bonferroni's correction. There were no other significant differences between Rapid Recovery and placebo. These data suggest that Rapid Recovery has no significant effect on alcohol hangover nor on associated biomarkers.

The Inflammatory Response to Alcohol Consumption and Its Role in the Pathology of Alcohol Hangover

An increasing number of studies are focusing on the inflammatory response to alcohol as a potentially important determinant of hangover severity. In this article, data from two studies were re-evaluated to investigate the relationship between hangover severity and relevant biomarkers of alcohol metabolism, oxidative stress and the inflammatory response to alcohol. Hangover severity was significantly and positively correlated with blood concentrations of biomarkers of the inflammatory response to alcohol, in particular, Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP). At 4 h after alcohol consumption, blood ethanol concentration (but not acetaldehyde) was significantly and positively associated with elevated levels of IL-6, suggesting a direct inflammatory effect of ethanol. In addition, biomarkers of oxidative stress, i.e., malondialdehyde and 8-isoprostrane, were significantly correlated with hangover severity, suggesting that oxidative stress also contributes to the inflammatory response. The timing of the assessments suggests initial slow elimination of ethanol in the first hours after alcohol consumption. As a consequence, more ethanol is present in the second half of the night and the next morning, which will elicit more oxidative stress and a more profound inflammatory response. Together, these processes result in more severe hangovers.

The Association between Ethanol Elimination Rate and Hangover Severity

Assessments in blood and saliva suggests that the amount of ethanol present in the first hours after alcohol consumption and into the following morning is associated with hangover severity. The current analysis determines how ethanol elimination rate is related to hangover severity reported throughout the day. n = 8 subjects participated in two studies. The first was a naturalistic study comprising an evening of alcohol consumption. Hangover severity was assessed hourly from 10 a.m. to 4 p.m., using a 1-item hangover severity scale ranging from 0 (absent) to 10 (extreme). The second study comprised a highly controlled alcohol challenge to reach a breath alcohol concentration (BrAC) of 0.05%. Breathalyzer tests were conducted every 5 min until BrAC reached zero. The ethanol elimination rate, expressed in BrAC%/hour, was computed by dividing the peak BrAC (%) by the time to BrAC of zero (h). At 11:00, 13:00, and 14:00, there were significant negative partial correlations, controlling for estimated BrAC, between ethanol elimination rate and hangover severity. The findings suggest that drinkers with a faster ethanol elimination rate experience less severe hangovers. The observations should be confirmed in a larger sample of subjects who participate in a single study that assesses both hangover severity and ethanol elimination rate.

Perceived Immune Fitness, Individual Strength and Hangover Severity

Various factors may contribute to alcohol hangover severity. The purpose of the current investigation was to evaluate the possible impact of alcohol consumption patterns, perceived immune status, and baseline fatigue on hangover severity. A survey was completed by a convenience sample of N = 199 Dutch students who reported on their latest past month's heavy drinking occasion, including subjective intoxication (perceived drunkenness) and next-day hangover severity, which were rated on single-item scales ranging from 0 (absent) to 10 (extreme). In addition, perceived (momentary) immune fitness was assessed, and the Checklist Individual Strength (CIS) was completed to assess baseline fatigue. The analysis revealed that instead of the amount of alcohol consumed or estimated blood alcohol concentration, it appeared that subjective intoxication (i.e., level of drunkenness) was the most important determinant of alcohol hangover severity. Especially in men, albeit modest, it was perceived that immune fitness also significantly contributed to the level of hangover severity experienced.

The Effects of Alcohol Hangover on Mood and Performance Assessed at Home

The current study evaluated the next day consequences of a social night of drinking compared to a no alcohol night, with standardised mood and portable screen-based performance measures assessed in the morning at participants’ homes, and a breathalyser screen for zero alcohol. A mixed sex group (n = 20) took part in the study. Participants reported consuming on average 16.9 units (135 g) alcohol, resulting in a hangover rating of 60 (out of 100) compared to 0.3 following the no alcohol night. Statistical significance comparisons contrasting the hangover with the no alcohol condition revealed an increase in negative mood and irritability during hangover and an (unexpected) increase in risk and thrill seeking. Performance scores showed an overall slowing of responses across measures, but with less impact on errors. The results support the description of hangover as a general state of cognitive impairment, reflected in slower responses and reduced accuracy across a variety of measures of cognitive function. This suggests a general level of impairment due to hangover, as well as increased negative mood. The use of a naturalistic design enabled the impact of more typical levels of alcohol associated with real life social consumption to be assessed, revealing wide ranging neurocognitive impairment with these higher doses. This study has successfully demonstrated the sensitivity of home-based assessment of the impact of alcohol hangover on a range of subjective and objective measures. The observed impairments, which may significantly impair daily activities such as driving a car or job performance, should be further investigated and taken into account by policy makers.

The Effects of SJP-001 on Alcohol Hangover Severity: A Pilot Study

Background. Despite a clear market need and many hangover products available, currently there is no hangover treatment that is supported by substantial scientific evidence demonstrating its efficacy and safety. A pilot study was conducted to investigate the effects of a potential new hangover treatment, SJP-001, and its constituents (220 mg naproxen and 60 mg fexofenadine) on hangover severity. Methods. N = 13 healthy social drinkers (36.3 ± 8.9 years old) participated in a double-blind, factorial design, cross-over study. On each test day, they consumed their own choice of alcohol up to a self-reported level sufficient to elicit a next-day hangover. Treatments were administered prior to onset of drinking. Next morning, hangover severity was assessed with the Acute Hangover Scale (AHS). Subjects were included in the efficacy analysis only if they reported a hangover after placebo. Results. N = 5 subjects (60% male, 35.2 ± 9.0 years old) were included in the analysis. They consumed a mean (SD) of 4.6 ± 1.1 units of alcohol and had an average peak breath alcohol concentration (BrAC) of 0.065% across conditions. Compared to placebo, SJP-001 significantly improved the AHS overall hangover severity score (0.8 ± 0.3 versus 1.5 ± 0.9, p = 0.042). Compared to placebo, SJP-001 also reduced scores on the individual item ‘hangover’, although the observed improvement (−1.6) did not reach statistical significance (p = 0.102). The differences from placebo after naproxen alone and fexofenadine alone were not statistically significant. SJP-001 also improved scores for the individual hangover symptoms tired, thirsty, headache, dizziness, nausea, and loss of appetite, but these effects did not reach statistical significance. Discussion. Compared to placebo, SJP-001 significantly reduced overall hangover severity. The effects of SJP-001 should be further examined in a double-blind, placebo-controlled trial with a larger sample size and controlled administration of sufficient amounts of alcohol to provoke a more substantial alcohol hangover.

Pain Catastrophising Predicts Alcohol Hangover Severity and Symptoms

Alcohol hangover is a cause of considerable social and economic burden. Identification of predictors of alcohol hangover severity have the potential to contribute to reductions in costs associated with both absenteeism/presenteeism and health care. Pain catastrophising (PC) is the tendency to ruminate and describe a pain experience in more exaggerated terms. The current study examines the possibility that this cognitive coping strategy may influence experience of alcohol hangover. The aims of the current study were to (1) examine the relationship between hangover severity and PC, (2) explore and identify discreet factors within the Acute Hangover Scale (AHS) and (3) explore whether independent factors/dimensions of acute hangover are differentially predicted by PC. A retrospective survey (n = 86) was conducted in which participants completed the Acute Hangover Scale (AHS); the Pain Catastrophising Scale (PCS); a questionnaire pertaining to the amount of alcohol consumed; and a demographic information questionnaire. Regression analyses showed a significant relationship between PC and hangover severity scores and demonstrated that PC was, in fact, a stronger predictor of perceived hangover severity than estimated peak blood alcohol concentrations (eBACs). Factor analysis of the AHS scale, resulted in the identification of two distinct symptom dimensions; ‘Headache and thirst’, and ‘Gastric and cardiovascular’ symptoms. Regression analyses showed that both eBAC and PCS score were significantly associated with ‘Headache and thirst’. However, only PCS score was associated with ‘Gastric and cardiovascular’ symptoms. These novel findings implicate a role for cognitive coping strategies in self-reports of alcohol hangover severity, and may have implications for understanding behavioural response to hangover, as well as suggesting that hangover and PC may be important factors mediating the motivation to drink and/or abuse alcohol, with potential implications in addiction research. Furthermore, these findings suggest that distinct alcohol hangover symptoms may be associated with different mechanisms underlying the experience of alcohol hangover.

Advantages and Limitations of Naturalistic Study Designs and their Implementation in Alcohol Hangover Research

In alcohol hangover research, both naturalistic designs and randomized controlled trials (RCTs) are successfully employed to study the causes, consequences, and treatments of hangovers. Although increasingly applied in both social sciences and medical research, the suitability of naturalistic study designs remains a topic of debate. In both types of study design, screening participants and conducting assessments on-site (e.g., psychometric tests, questionnaires, and biomarker assessments) are usually equally rigorous and follow the same standard operating procedures. However, they differ in the levels of monitoring and restrictions imposed on behaviors of participants before the assessments are conducted (e.g., drinking behaviors resulting in the next day hangover). These behaviors are highly controlled in RCTs and uncontrolled in naturalistic studies. As a result, the largest difference between naturalistic studies and RCTs is their ecological validity, which is usually significantly lower for RCTs and (related to that) the degree of standardization of experimental intervention, which is usually significantly higher for RCTs. In this paper, we specifically discuss the application of naturalistic study designs and RCTs in hangover research. It is debated whether it is necessary to control certain behaviors that precede the hangover state when the aim of a study is to examine the effects of the hangover state itself. If the preceding factors and behaviors are not in the focus of the research question, a naturalistic study design should be preferred whenever one aims to better mimic or understand real-life situations in experimental/intervention studies. Furthermore, to improve the level of control in naturalistic studies, mobile technology can be applied to provide more continuous and objective real-time data, without investigators interfering with participant behaviors or the lab environment impacting on the subjective state. However, for other studies, it may be essential that certain behaviors are strictly controlled. It is, for example, vital that both test days are comparable in terms of consumed alcohol and achieved hangover severity levels when comparing the efficacy and safety of a hangover treatment with a placebo treatment day. This is best accomplished with the help of a highly controlled RCT design.

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.

Dietary Nutrient Intake, Alcohol Metabolism, and Hangover Severity

Several dietary components have been shown to influence alcohol metabolism and thereby potentially affect the development of a hangover. From the literature, it is evident that dietary nicotinic acid and zinc play a pivotal role in the oxidation of ethanol into acetaldehyde. The aim of the current study was to associate dietary intake of nicotinic acid and zinc with hangover severity. To this end, data from n = 23 healthy social drinkers who participated in a naturalistic hangover study were analyzed. n = 10 of them reported to be hangover-resistant (the control group), whereas n = 13 reported to have regular hangovers (the hangover-sensitive group). Two 24 h dietary recall records were completed, one for the day of alcohol consumption and another one for an alcohol-free control day. Dietary nutrient intake was averaged and did not significantly differ between hangover-sensitive and hangover-resistant drinkers. For the hangover-sensitive drinkers, partial correlations with overall hangover severity were computed, controlling for estimated blood alcohol concentration. A bootstrapping technique was applied to account for the relatively small sample size. The results showed that dietary intake of nicotinic acid (r_PB = −0.521) and zinc (r_PB = −0.341) were significantly and negatively associated (p < 0.002) with overall hangover severity. Dietary zinc intake was also significantly and negatively associated with severity of vomiting (r_PB = −0.577, p < 0.002). No significant associations with hangover severity were found for other nutrients, such as fat and fibers. In conclusion, this study suggests that social drinkers who have a higher dietary intake of nicotinic acid and zinc report significantly less severe hangovers. As hangover-resistant and hangover-sensitive drinkers had a similar dietary nutrient intake, the claim of being hangover-resistant must be based on other unknown biopsychosocial factors. These findings should be replicated in a larger sample and include more elaborate food frequency questionnaires or nutrient-specific dietary intake records for zinc and nicotinic acid, and preferably accompanied by nutrient assessments in urine and/or blood.

Effects of Alcohol Hangover on Cognitive Performance: Findings from a Field/Internet Mixed Methodology Study

Results from studies into the cognitive effects of alcohol hangover have been mixed. They also present methodological challenges, often relying on self-reports of alcohol consumption leading to hangover. The current study measured Breath Alcohol Concentration (BAC, which was obtained via breathalyzer) and self-reported drinking behavior during a night out. These were then related to hangover severity and cognitive function, measured over the internet in the same subjects, the following morning. Volunteers were breathalyzed and interviewed as they left the central entertainment district of an Australian state capital. They were provided with a unique identifier and, the following morning, logged on to a website. They completed a number of measures including an online version of the Alcohol Hangover Severity Scale (AHSS), questions regarding number and type of drinks consumed the previous night, and the eTMT-B-a validated, online analogue of the Trail Making Test B (TMT-B) of executive function and working memory. Hangover severity was significantly correlated with one measure only, namely the previous night's Breath Alcohol Concentration (r = 0.228, p = 0.019). Completion time on the eTMT-B was significantly correlated with hangover severity (r = 0.245, p = 0.012), previous night's BAC (r = 0.197, p = 0.041), and time spent dinking (r = 0.376, p < 0.001). These findings confirm that alcohol hangover negatively affects cognitive functioning and that poorer working memory and executive performance correlate with hangover severity. The results also support the utility and certain advantages of using online measures in hangover research.

Susceptibility to Alcohol Hangovers: Not Just a Matter of Being Resilient

Introduction

Although most drinkers have experienced a hangover the day following heavy alcohol consumption, a minority claims to be hangover resistant despite consuming the same large quantities of alcohol as those reporting alcohol hangover. The aim of the current study was to examine if susceptibility to experiencing hangovers is related to a drinker's interpretation of wellbeing and psychological assets to bounce back.

Methods

A survey was conducted among 2295 Dutch students assessing their past month alcohol consumption patterns, and measuring mental resilience and wellbeing. Estimated peak blood alcohol concentration (e-pBAC) for their heaviest drinking occasion in the past month was computed for each participant. Data from participants who reported a past month hangover, i.e. hangover sensitive drinkers, were compared with hangover resistant drinkers. The analyses were conducted for (a) all participants reaching an e-pBAC ≥ 0.11% (N = 986, of which 24.6% claimed to be hangover resistant) and (b) participants reaching an e-pBAC ≥ 0.18% (N = 480, of which 16.7% claimed to be hangover resistant).

Results

For both e-pBAC cut-off values, no significant differences between hangover sensitive and hangover resistant drinkers were found for mental resilience and wellbeing.

Conclusion

The current findings suggest that having a hangover is not simply an expression of poor psychological coping with the next-day consequences of heavy alcohol consumption.

Clove Bud Polyphenols Alleviate Alterations in Inflammation and Oxidative Stress Markers Associated with Binge Drinking: A Randomized Double-Blinded Placebo-Controlled Crossover Study

Acetaldehyde, the major cytotoxin formed by the metabolism of alcohol, is responsible for liver injury, extracellular matrix alterations, inflammation, and hangover in heavy drinkers. This study aimed to demonstrate the efficacy of a standardized polyphenolic extract of clove buds (Clovinol) in ameliorating the oxidative stress and inflammation caused by the accumulation of acetaldehyde after binge drinking. We used a randomized, double-blinded crossover study with 16 male social drinkers. The subjects were randomized into two groups of eight subjects and received either placebo or Clovinol in a single hard shell gelatin capsule (250 mg × 1) per day. The dosage of alcohol was 1 g/kg body weight/day. After 2 weeks of washout period, the treatment regime was reversed. Blood samples were drawn at 0, 0.5, 2, 4, and 12 h after treatment with either placebo or Clovinol, and biochemical parameters were analyzed. Hangover severity score was determined by using a validated questionnaire as reported earlier. Results showed faster elimination of blood acetaldehyde with significant decreases in oxidative stress, lipid peroxidation, C-reactive protein, interleukin-6, and significant enhancement in glutathione and superoxide dismutase as compared with placebo along with an overall reduction of 55.34% in hangover severity in Clovinol-treated subjects. This study demonstrated the efficacy of clove bud polyphenols for alleviating alcohol-related side effects among social drinkers at the studied dose.

Impact of mental resilience and perceived immune functioning on the severity of alcohol hangover

Objective

Recent research comparing hangover sensitive drinkers with hangover resistant drinkers has revealed that experiencing alcohol hangovers is associated with significantly poorer self-reported immune functioning (p < 0.0001). No significant difference between the groups was found on mental resilience. The objective of the current survey was to examine the association between hangover severity, perceived immune status, and mental resilience. N = 341 Dutch students, all hangover sensitive drinkers, completed an online survey. The Brief Resilience Scale was completed, and perceived immune functioning and overall hangover severity for their latest past month hangover were assessed.

Results

Students consumed a mean (SD) of 12.3 (5.9) alcoholic drinks the evening before their latest hangover. A significant positive association was found between mental resilience and perceived immune functioning (r = 0.372, p = 0.000). No significant associations of hangover severity were found with mental resilience (r = − 0.010, p = 0.858), or perceived immune functioning (r = − 0.025, p = 0.645). Previous research revealed that hangover resistant and hangover sensitive drinkers report having significantly different levels of immune functioning, and that the immune system is involved in the development of alcohol hangover. These findings suggest that levels of mental resilience and perceived immune functioning are not related to the severity of hangovers in hangover sensitive drinkers.

Pharmacological manipulation of the ghrelin system and alcohol hangover symptoms in heavy drinking individuals: Is there a link?

Ghrelin, an orexigenic peptide synthesized in the stomach, is a key player in the gut-brain axis. In addition to its role in regulating food intake and energy homeostasis, ghrelin has been shown to modulate alcohol-related behaviors. Alcohol consumption frequently results in hangover, an underexplored phenomenon with considerable medical, psychological, and socioeconomic consequences. While the pathophysiology of hangover is not clear, contributions of mechanisms such as alcohol-induced metabolic/endocrine changes, inflammatory/immune response, oxidative stress, and gut dysbiosis have been reported. Interestingly, these mechanisms considerably overlap with ghrelin's physiological functions. Here, we investigated whether pharmacological manipulation of the ghrelin system may affect alcohol hangover symptoms. Data were obtained from two placebo-controlled laboratory studies. The first study tested the effects of intravenous (IV) ghrelin and consisted of two experiments: a progressive-ratio IV alcohol self-administration (IV-ASA) and a fixed-dose IV alcohol clamp. The second study tested the effects of an oral ghrelin receptor inverse agonist (PF-5190457) and included a fixed-dose oral alcohol administration experiment. Alcohol hangover data were collected the morning after each alcohol administration experiment using the Acute Hangover Scale (AHS). IV ghrelin, compared to placebo, significantly reduced alcohol hangover after IV-ASA (p = 0.04) and alcohol clamp (p = 0.04); PF-5190457 had no significant effect on AHS scores. Females reported significantly higher hangover symptoms than males following the IV-ASA experiment (p = 0.04), but no gender × drug condition (ghrelin vs. placebo) effect was found. AHS total scores were positively correlated with peak subjective responses, including 'stimulation' (p = 0.08), 'sedation' (p = 0.009), 'feel high' (p = 0.05), and 'feel intoxicated' (p = 0.03) during the IV-ASA. IV ghrelin blunted the positive association between alcohol sedation and hangover as shown by trend-level drug × sedation effect (p = 0.08). This is the first study showing that exogenous ghrelin administration, but not ghrelin receptor inverse agonism, affects hangover symptoms. Future research should investigate the potential mechanism(s) underlying this effect.

Susceptibility to Alcohol Hangovers: The Association with Self-Reported Immune Status

Increasing evidence points at a role for the immune system in the genesis of the alcohol hangover. This study investigated the association between self-reported immune function and experiencing hangovers. Dutch students aged 18 to 30 years old were invited to complete an online survey. Eighteen items on immune-related complaints were completed to assess self-reported immune function. Alcohol consumption in the past month (with respect to usual consumption and the occasion of heaviest drinking) was also recorded. Subjects with an estimated blood alcohol concentration (eBAC) of 0.18% or higher on their heaviest drinking occasion in the prior month were included in the analyses. Self-reported immune function was compared between drinkers with a hangover and those who claimed to be hangover resistant. In total, of 481 subjects (79.2% women) with a mean (SD) age of 21.1 (1.9) years old were included in the analysis. Of these, 83.3% (n = 400) reported having hangovers and 16.8% (n = 81) claimed to be hangover resistant. Drinkers with hangovers had significantly higher self-reported overall immune function scores when compared to hangover-resistant drinkers (mean ± SD = 10.5 ± 3.6 versus 13.1 ± 4.9, p = 0.0001), indicating a poorer immune status. In conclusion, experiencing alcohol hangovers is associated with significantly poorer self-reported immune function.

Alcohol metabolism in hangover sensitive versus hangover resistant social drinkers

BACKGROUND

Previous research demonstrated that urinary ethanol concentrations were significantly lower in hangover resistant individuals compared to drinkers who reported having a hangover. This finding suggests that the rate of ethanol metabolism is faster in drinkers who do not experience an alcohol hangover. This study aimed to directly compare alcohol metabolism after administering a low dose of ethanol to hangover sensitive drinkers and hangover resistant drinkers.

METHODS

Social drinkers who previously participated in hangover trials at Utrecht University were invited to participate. It was aimed to include 12 hangover resistant drinkers and 12 hangover sensitive drinkers. Participants consumed alcohol to reach a breath alcohol concentration (BrAC) of 0.05%. Every 5 min BrAC was determined, until BrAC reached zero. Every 15 min, the Karolinska Sleeping Scale (KSS) was administered to assess subjective sleepiness, and subjective intoxication was measured.

RESULTS

Data of N = 23 participants with a mean age of 22.4 (±1.9) years was included in the analyses. No significant difference in BrAC over time was found between the hangover resistant group and the hangover sensitive group. In line, subjective sleepiness scores and subjective intoxication ratings did not significantly differ between the groups at any point in time after alcohol consumption.

CONCLUSION

Hangover resistant individuals and hangover sensitive drinkers did not significantly differ on BrAC, subjective sleepiness, and subjective intoxication after consuming a moderate amount of alcohol. These findings suggest that drinkers who usually experience hangovers after a heavy drinking occasion do not experience alcohol intoxication differently than hangover resistant drinkers.

The effects of alcohol hangover on future drinking behavior and the development of alcohol problems

INTRODUCTION

Alcohol hangover experiences in young adulthood have been shown to predict more subsequent alcohol problems. Hangover susceptibility appears to be partially heritable and related to family history of alcohol use disorders. However, very little is known about the developmental course of these associations and whether they are accounted for by an individual's drinking history. The goal of this study is to investigate the prospective and unique relationships between family history of alcohol use disorders, severity of alcohol hangover experiences in adolescence, and later alcohol use and related problems measured over 13years.

METHODS

Participants were first assessed on family history at age 12-14, prior to initiating drinking, and re-assessed annually on hangover severity, drinks per drinking day (DPDD), and alcohol-related problems throughout the 13-year follow-up period (n=205; 59% male).

RESULTS

In mixed effects negative binomial regression models, greater family history density scores predicted more future DPDD (Incidence Rate Ratio [IRR]=1.19, p=0.04), alcohol problems (IRR=1.64, p=0.05), and future hangover severity (IRR=1.24; p=0.01). In turn, greater hangover severity predicted more future DPDD (IRR=1.03; p=0.002) and alcohol problems (IRR=1.12, p<0.001), and hangover severity mediated the relationship between family history and alcohol use/problems. All models controlled for participant age, sex, and past drinking behavior (where relevant).

CONCLUSIONS

These results advance the alcohol hangover experience during late adolescence as a clinically relevant and uniquely informative marker of future alcohol use and problems, above and beyond that of prior personal or familial drinking history.

Adolescent brain cognitive development (ABCD) study: Overview of substance use assessment methods

One of the objectives of the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org/) is to establish a national longitudinal cohort of 9 and 10 year olds that will be followed for 10 years in order to prospectively study the risk and protective factors influencing substance use and its consequences, examine the impact of substance use on neurocognitive, health and psychosocial outcomes, and to understand the relationship between substance use and psychopathology. This article provides an overview of the ABCD Study Substance Use Workgroup, provides the goals for the workgroup, rationale for the substance use battery, and includes details on the substance use module methods and measurement tools used during baseline, 6-month and 1-year follow-up assessment time-points. Prospective, longitudinal assessment of these substance use domains over a period of ten years in a nationwide sample of youth presents an unprecedented opportunity to further understand the timing and interactive relationships between substance use and neurocognitive, health, and psychopathology outcomes in youth living in the United States.

Behavioral effects of the combined use of alcohol and energy drinks on alcohol hangover in an experimental mice model

In last few years it has been a significant increase in the consumption of alcohol combined with energy drink. The aim of this work was to study the effect of this mixture in motor and affective behaviors during an alcohol hangover episode. Male Swiss mice received one of the following treatments: saline + sucrose; saline + energy drink; ethanol + sucrose; ethanol + energy drink. Ethanol dose was 3.8 g/kg BW (i.p.) and energy drink dose was 18 ml/kg BW (gavage) at ZT1 (8 am) (ZT: Zeitgeber time; ZT0: 7 am; lights on). The behavioral tests used were tight rope test to determine motor coordination; hanging wire test to study muscular strength; elevated plus maze and open field tests to evaluate anxiety like-behavior and locomotor activity. Tests were carried out at basal point that matched with lights onset and every 6 h up to 18 h after treatments. Hangover onset was established at ZT7 when blood alcohol concentration (BAC) was almost zero. Our results showed that the mixture of alcohol and energy drink altered significantly motor skills. Specifically, a significant decrease was observed in the performance of the animals in the tightrope and hanging wire tests in groups treated with the mixture of alcohol and energy drink. A significant impairment in the anxiety-like behavior was observed mainly at the beginning of alcohol hangover. These findings suggest that energy drink added to alcohol extends motor disabilities observed during an alcohol hangover episode in comparison with animals that received alcohol alone.

Interventions for treatment and/or prevention of alcohol hangover: Systematic review

OBJECTIVE

To evaluate new research conducted over the past few years (2009-2016) assessing the effectiveness of potentially curative and/or preventive methods of alcohol hangover.

METHODS

Data were retrieved by a 4-stage systematic search process. A search of the online Pubmed and Scopus databases were performed, using a combination of keywords: "Alcohol," "Ethanol," and "C₂ H₅ OH," in combination with the terms "Hangover," "Treatment," and "Prevention." The search comprised studies listed between January 1, 2009 and June 30, 2016. Findings were synthesized using a systematic approach. Quantitative analysis was not done because of the heterogeneity of the included studies.

RESULTS

Six controlled human studies were identified (placebo controlled-3, controlled studies with a comparator intervention-3). Of the interventions, the use of polysaccharide rich extract of Acanthopanax senticosus, red ginseng antihangover drink, Korean pear juice, KSS formula, and the After-Effect© were associated with a significant improvement of hangover symptoms (p < .05). The highest improvement was observed for the following symptoms: tiredness, nausea/vomiting, and stomachache. None of the methods were effective for all the symptoms.

CONCLUSION

The available evidence suggests that several products are capable of significantly improving some, but not all, of the symptoms related to alcohol hangover. Therefore, further research is necessary to develop clinically effective hangover treatments.

Hangover Symptoms, Heavy Episodic Drinking, and Depression in Young Adults: A Cross-Lagged Analysis

OBJECTIVE

The objective of this study was to examine associations between symptoms of alcohol hangover and depression, both cross-sectionally and prospectively.

METHOD

Data were from a survey of young adults (N = 986, 60% female) initially recruited as part of an observational study of youth smoking. Participants reported past-year hangover symptoms, past-year frequency of heavy episodic drinking (HED), and past-week depression symptoms on two occasions separated by 1 year. Path analysis was used to evaluate prospective, directional associations linking symptoms of depression and hangover after taking into account their stabilities and cross-sectional associations. Individual differences in HED frequency were accounted for to permit interpretation of residual hangover score variance in terms of susceptibility to hangover effects.

RESULTS

Past-week depression and past-year hangover symptoms were associated at Time 1. Path analysis indicated that Time 1 depression symptoms were associated with elevated hangover symptoms a year later at Time 2. In contrast, Time 1 hangover symptoms did not predict future depression.

CONCLUSIONS

Depression symptoms are associated with current and future hangover susceptibility. Hangover and depression overlap symptomatically and are empirically associated with one another, suggesting the possibility that common underlying causal mechanisms may contribute to both phenomena.

Thirst sensation and oral dryness following alcohol intake

Substantial acute and chronic intakes of alcohol or ethanol (EtOH) severely influence oral sensations, such as thirst and oral dryness (dry mouth, xerostomia). Thirst sensation and oral dryness are primarily caused by the activation of neurons in brain regions, including the circumventricular organs and hypothalamus, which are referred to as the dipsogenic center, and by a decrease in salivary secretion, respectively. The sensation of thirst experienced after heavy-alcohol drinking is widely regarded as a consequence of EtOH-induced diuresis; however, EtOH in high doses induces anti-diuresis. Recently, it has been proposed that the ethanol metabolite acetaldehyde induces thirst via two distinct processes in the central nervous system from EtOH-induced diuresis, based on the results of animal experiments. The present review describes new insights regarding the induction mechanism of thirst sensation and oral dryness after drinking alcohol.

Urine methanol concentration and alcohol hangover severity

BACKGROUND

Congeners are substances, other than ethanol, that are produced during fermentation. Previous research found that the consumption of congener-rich drinks contributes to the severity of alcohol hangover. Methanol is such a congener that has been related to alcohol hangover. Therefore, the aim of this study was to examine the relationship between urine methanol concentration and alcohol hangover severity.

METHODS

N = 36 healthy social drinkers (22 females, 14 males), aged 18-30 years old, participated in a naturalistic study, comprising a hangover day and a control day (no alcohol consumed the previous day). N = 18 of them had regular hangovers (the hangover group), while the other N = 18 claimed to be hangover-immune (hangover-immune group). Overall hangover severity was assessed, and that of 23 individual hangover symptoms. Urine methanol concentrations on the hangover and control days were compared, and correlated to hangover (symptom) severity.

RESULTS

Urine methanol concentration was significantly higher on hangover days compared to control days (p = 0.0001). No significant differences in urine methanol concentration were found between the hangover group and hangover-immune group. However, urine methanol concentration did not significantly correlate with overall hangover severity (r = -0.011, p = 0.948), nor with any of the individual hangover symptoms. These findings were observed also when analyzing the data separately for the hangover-immune group. In the hangover group, a significant correlation with urine methanol concentration was found only with vomiting (r = 0.489, p = 0.037).

CONCLUSION

No significant correlation was observed between urine methanol concentration and hangover severity, nor with individual core hangover symptoms.

Urine ethanol concentration and alcohol hangover severity

BACKGROUND

The aim of this study was to examine the relationship between urine ethanol concentration and alcohol hangover severity.

METHODS

N = 36 healthy social drinkers participated in a naturalistic study, comprising a hangover day and a control day. N = 18 of them have regular hangovers (the hangover group), while the other N = 18 claim to be hangover immune (hangover-immune group). On each test day at 9.30 am, urine samples were collected. Participants rated their overall hangover severity on a scale from 0 (absent) to 10 (extreme), as well as 18 individual hangover symptoms.

RESULTS

Urine ethanol concentration was significantly higher on the hangover day when compared to the control day (p = 0.006). On the hangover day, urine ethanol concentration was significantly lower in the hangover-immune group when compared to the hangover group (p = 0.027). In the hangover-immune group, none of the correlations of urine ethanol concentration with individual hangover symptoms was significant. In contrast, in the hangover group, significant correlations were found with a variety of hangover symptoms, including nausea, concentration problems, sleepiness, weakness, apathy, sweating, stomach pain, thirst, heart racing, anxiety, and sleep problems.

CONCLUSION

Urine ethanol levels are significantly associated with the presence and severity of several hangover symptoms.

Does familial risk for alcohol use disorder predict alcohol hangover?

AIMS

Positive family history of alcohol use disorder (FHP), a variable associated with propensity for alcohol use disorder (AUD), has been linked with elevated hangover frequency and severity, after controlling for alcohol use. This implies that hangover experiences may be related to AUD. However, inadequate control of alcohol consumption levels, low alcohol dose and testing for hangover during the intoxication phase detract from these findings. Here, we present further data pertinent to understanding the relationship between family history and alcohol hangover.

METHODS

Study 1 compared past year hangover frequency in a survey of 24 FHP and 118 family history negative (FHN) individuals. Study 2 applied a quasi-experimental naturalistic approach assessing concurrent hangover severity in 17 FHP and 32 FHN individuals the morning after drinking alcohol. Both studies applied statistical control for alcohol consumption levels.

RESULTS

In Study 1, both FHP status and estimated blood alcohol concentration on the heaviest drinking evening of the past month predicted the frequency of hangover symptoms experienced over the previous 12 months. In Study 2, estimated blood alcohol concentration the previous evening predicted hangover severity but FHP status did not.

CONCLUSIONS

FHP, indicating familial risk for AUD, was not associated with concurrent hangover severity but was associated with increased estimates of hangover frequency the previous year.

Characteristics of social drinkers with and without a hangover after heavy alcohol consumption

Background

A number of social drinkers claim that they do not experience next-day hangovers despite consuming large quantities of alcohol. The aim of this study was to investigate the characteristics of drinkers who claim to be hangover immune and compare them with drinkers who do report having hangovers.

Methods

A total of 36 social drinkers participated in a naturalistic study consisting of a hangover day (alcohol consumed) and a control day (no alcohol consumed). Data were collected on alcohol consumption, demographics, sleep, next-day adverse effects, and mood. Data from drinkers with a hangover (N=18) were compared with data from drinkers who claim to be hangover immune (N=18).

Results

Drinkers with a hangover reported drowsiness-related symptoms, symptoms related to reduced cognitive functioning, and classic hangover symptoms such as headache, nausea, dizziness, weakness, and stomach pain. Corresponding mood changes comprised increased feelings of depression, anger–hostility, fatigue, and reduced vigor–activity. In contrast, hangover-immune drinkers reported relatively few hangover symptoms, with only mild corresponding severity scores. The reported symptoms were limited to drowsiness-related symptoms such as sleepiness and being tired. The classic hangover symptoms were usually not reported by these drinkers.

Conclusion

In contrast to drinkers with a hangover, for those who claim to be hangover immune, next-day adverse effects of alcohol consumption are limited to a mild increase in drowsiness-related symptoms.

The effect of alcohol hangover on choice response time

The effect of alcohol hangover on cognitive processing has received little attention. We explored the effect of alcohol hangover on choice response time (RT), a dominant dependent variable (DV) in cognitive research. Prior research of the effect of hangover on RT has produced mixed findings; all studies reviewed relied exclusively on estimates of central tendency (e.g. mean RT), which has limited information value. Here we present novel analytical methods by going beyond mean RT analysis. Specifically, we examined performance in hangover conditions (n=31) across the whole RT distribution by fitting ex-Gaussian models to participant data, providing a formal description of the RT distribution. This analysis showed detriments to performance under hangover conditions at the slower end of the RT distribution and increased RT variance under hangover conditions. We also fitted an explicit mathematical process model of choice RT - the diffusion model - which estimates parameters reflecting psychologically-meaningful processes underlying choice RT. This analysis showed that hangover reduced information processing efficiency during response selection, and increased response caution; changes in these parameters reflect hangover affecting core decisional-components of RT performance. The implications of the data as well as the methods used for hangover research are discussed.

Metabolic methanol: molecular pathways and physiological roles

Methanol has been historically considered an exogenous product that leads only to pathological changes in the human body when consumed. However, in normal, healthy individuals, methanol and its short-lived oxidized product, formaldehyde, are naturally occurring compounds whose functions and origins have received limited attention. There are several sources of human physiological methanol. Fruits, vegetables, and alcoholic beverages are likely the main sources of exogenous methanol in the healthy human body. Metabolic methanol may occur as a result of fermentation by gut bacteria and metabolic processes involving S-adenosyl methionine. Regardless of its source, low levels of methanol in the body are maintained by physiological and metabolic clearance mechanisms. Although human blood contains small amounts of methanol and formaldehyde, the content of these molecules increases sharply after receiving even methanol-free ethanol, indicating an endogenous source of the metabolic methanol present at low levels in the blood regulated by a cluster of genes. Recent studies of the pathogenesis of neurological disorders indicate metabolic formaldehyde as a putative causative agent. The detection of increased formaldehyde content in the blood of both neurological patients and the elderly indicates the important role of genetic and biochemical mechanisms of maintaining low levels of methanol and formaldehyde.