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Sensitivity to Experiencing Alcohol Hangovers: Reconsideration of the 0.11% Blood Alcohol Concentration (BAC) Threshold for Having a Hangover

Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584CG Utrecht, The Netherlands
Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584CM Utrecht, The Netherlands
Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia
Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS B4P 2R6, Canada
Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath BA2 7AY, UK
Psychological Sciences Research Group, University of the West of England, Bristol BS16 1QY, UK
Education and Social Sciences, University of the West of Scotland, Paisley PA1 2BE, UK
School of Psychology, Life and Health Sciences, Ulster University, Coleraine, Co. Londonderry BT52 1SA, UK
Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA
Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
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
Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK
Department of Psychology, School of Health and Society, University of Salford, Salford 5 M6 6PU, UK
Department of Medicine, Imperial College London, London W12 0NN, UK
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
Cognitive Neurophysiology Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, University of Dresden, D-01307 Dresden, Germany
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(1), 179;
Received: 7 December 2019 / Revised: 28 December 2019 / Accepted: 7 January 2020 / Published: 9 January 2020
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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. View Full-Text
Keywords: alcohol; hangover; sensitivity; subjective intoxication; blood alcohol concentration alcohol; hangover; sensitivity; subjective intoxication; blood alcohol concentration
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Verster, J.C.; Kruisselbrink, L.D.; Slot, K.A.; Anogeianaki, A.; Adams, S.; Alford, C.; Arnoldy, L.; Ayre, E.; Balikji, S.; Benson, S.; Bruce, G.; Devenney, L.E.; Frone, M.R.; Gunn, C.; Heffernan, T.; Hensel, K.O.; Hogewoning, A.; Johnson, S.J.; van Lawick van Pabst, A.E.; van de Loo, A.J.; Mackus, M.; Merlo, A.; Murphy, R.J.; Owen, L.; Palmer, E.O.; van Rossum, C.J.; Scholey, A.; Terpstra, C.; Vatsalya, V.; Vermeulen, S.A.; van Wijk, M.; Stock, A.-K., on behalf of the Alcohol Hangover Research Group; Sensitivity to Experiencing Alcohol Hangovers: Reconsideration of the 0.11% Blood Alcohol Concentration (BAC) Threshold for Having a Hangover. J. Clin. Med. 2020, 9, 179.

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