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The Alcohol Hangover: Causes, Consequences, and Treatment
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The Alcohol Hangover: Causes, Consequences, and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (31 May 2020) | Viewed by 141210

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Joris C. Verster

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Guest Editor
1. Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
2. Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia
Interests: immune fitness; COVID-19; mood; sleep; alcohol; hangover
Special Issues, Collections and Topics in MDPI journals
Ms. Lizanne Arnoldy

E-Mail
Guest Editor
1. Research intern at Utrecht University, Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacology, Utrecht, The Netherlands
2. MSc student Pharmaceutical Sciences, Utrecht, The Netherlands
Interests: alcohol; hangover; human psychopharmacology; clinical pharmacology
Dr. Sarah Benson

E-Mail Website
Co-Guest Editor
Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia
Interests: cognitive psychology; psychopharmacology; alcohol; caffeine; cognitive enhancement; alcohol hangover
Prof. Dr. Andrew Scholey

E-Mail Website
Co-Guest Editor
Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia
Interests: cognitive psychology; psychopharmacology; nutrition and brain function; herbal extracts; effects of natural substances on brain function; cognition enhancement; dementias; drugs and behavior; alcohol; caffeine
Special Issues, Collections and Topics in MDPI journals
Dr. Ann-Kathrin Stock

E-Mail Website
Co-Guest Editor
1. Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
2. Biopsychology, Department of Psychology, School of Science, TU Dresden, Zellescher Weg 19, 01069 Dresden, Germany
Interests: alcohol; hangover; action control; executive functioning; automated behavior; GABA; dopamine; amphetamines

Special Issue Information

Dear Colleagues,

Since the founding of the Alcohol Hangover Research Group in 2010, research on alcohol hangovers is increasing and on the move. This research focusses on the causes, consequences, and treatment of the alcohol hangover.

The alcohol hangover refers to the combination of mental and physical symptoms experienced the day after a single episode of heavy drinking, starting when the blood alcohol concentration approaches zero (Van Schrojenstein Lantman et al., 2016). Research has identified as many as 47 different symptoms that can be experienced during the alcohol hangover state (Penning et al., 2012). A recent study investigated the presence and severity of the most common hangover symptoms among 1,837 social drinkers (Van Schrojenstein Lantman et al., 2017). The four symptoms with the biggest combined impact on mood, cognitive performance, and physical functioning were being tired, sleepiness, concentration problems, and headache. Research has pointed at the socioeconomic consequences of experiencing these symptoms in terms of absenteeism versus presenteeism and an increased risk of having accidents. Alcohol hangover effects can also significantly impair daily activities such as driving a car.

Today, much remains unknown about the pathology of the alcohol hangover. However, current research into alcohol metabolism and the immune system significantly increases our understanding of the alcohol hangover. Other researchers have focused on genetics, behavioral aspects, personality, and psychological correlates of the alcohol hangover, or the impact of food and daily diet. The obtained knowledge is essential to developing the ideal hangover treatment. Unfortunately, despite the high consumer demand for an effective and safe hangover treatment, scientific research on the efficacy of hangover treatments and cures is scarce.

The present Special Issue aims to provide an overview of the latest research on the causes, consequences and treatment of the alcohol hangover. The combination of original research articles and review papers will provide clinicians with up-to-date knowledge on the alcohol hangover.

Dr. Joris C Verster
Ms. Lizanne Arnoldy
Dr. Sarah Benson
Prof. Dr. Andrew Scholey
Dr. Ann-Kathrin Stock
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Alcohol
  • Hangover
  • Pathology
  • Treatment
  • Cognitive functioning
  • Physical functioning
  • Mood
  • Predictors

Published Papers (26 papers)

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Editorial

Jump to: Research, Review, Other

7 pages, 571 KiB  
Editorial
The Alcohol Hangover Research Group: Ten Years of Progress in Research on the Causes, Consequences, and Treatment of the Alcohol Hangover
by Joris C. Verster, Lizanne Arnoldy, Sarah Benson, Andrew Scholey and Ann-Kathrin Stock
J. Clin. Med. 2020, 9(11), 3670; https://doi.org/10.3390/jcm9113670 - 16 Nov 2020
Cited by 3 | Viewed by 6040
Abstract
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, [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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Research

Jump to: Editorial, Review, Other

11 pages, 595 KiB  
Article
Prevalence of Hangover Resistance According to Two Methods for Calculating Estimated Blood Alcohol Concentration (eBAC)
by Chantal Terpstra, Andrew Scholey, Joris C. Verster and Sarah Benson
J. Clin. Med. 2020, 9(9), 2823; https://doi.org/10.3390/jcm9092823 - 31 Aug 2020
Cited by 7 | Viewed by 2863 | Correction
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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14 pages, 448 KiB  
Article
The Impact of Mood and Subjective Intoxication on Hangover Severity
by Joris C. Verster, Lizanne Arnoldy, Aurora J.A.E. van de Loo, Sarah Benson, Andrew Scholey and Ann-Kathrin Stock
J. Clin. Med. 2020, 9(8), 2462; https://doi.org/10.3390/jcm9082462 - 01 Aug 2020
Cited by 18 | Viewed by 3088
Abstract
The aim of this study was to investigate whether baseline mood and/or mood while drinking have an impact on alcohol hangover severity. A survey was held among N = 331 young adults (mean age = 23.6 years, range = 18–35 years). Demographics, alcohol [...] Read more.
The aim of this study was to investigate whether baseline mood and/or mood while drinking have an impact on alcohol hangover severity. A survey was held among N = 331 young adults (mean age = 23.6 years, range = 18–35 years). Demographics, alcohol consumption, subjective intoxication, and hangover severity were assessed for the past three days. In addition, mood (baseline, while drinking, and during hangover) was also assessed. N = 143 participants reported to be hungover on the day of assessment, N = 122 participants reported to have been hungover the previous day (‘yesterday’), and N = 87 participants reported to have been hungover two days before the assessment (‘2 days ago’). The analyses revealed that baseline mood and mood while drinking had no relevant effect on the amount of consumed alcohol and did not significantly contribute to hangover severity. However, hangover severity was associated with significantly increased negative affect, particularly with higher levels of subjective stress on the day of the hangover. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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12 pages, 288 KiB  
Article
Effects of Rapid Recovery on Alcohol Hangover Severity: A Double-Blind, Placebo-Controlled, Randomized, Balanced Crossover Trial
by Andrew Scholey, Elizabeth Ayre, Ann-Kathrin Stock, Joris C Verster and Sarah Benson
J. Clin. Med. 2020, 9(7), 2175; https://doi.org/10.3390/jcm9072175 - 09 Jul 2020
Cited by 7 | Viewed by 3825
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
12 pages, 1333 KiB  
Article
The Inflammatory Response to Alcohol Consumption and Its Role in the Pathology of Alcohol Hangover
by Aurora J.A.E. van de Loo, Marlou Mackus, Oran Kwon, Illathu Madhavamenon Krishnakumar, Johan Garssen, Aletta D. Kraneveld, Andrew Scholey and Joris C. Verster
J. Clin. Med. 2020, 9(7), 2081; https://doi.org/10.3390/jcm9072081 - 02 Jul 2020
Cited by 26 | Viewed by 5885
Abstract
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, [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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20 pages, 2096 KiB  
Article
Alcohol Hangover Does Not Alter the Application of Model-Based and Model-Free Learning Strategies
by Julia Berghäuser, Wiebke Bensmann, Nicolas Zink, Tanja Endrass, Christian Beste and Ann-Kathrin Stock
J. Clin. Med. 2020, 9(5), 1453; https://doi.org/10.3390/jcm9051453 - 13 May 2020
Cited by 3 | Viewed by 3007
Abstract
Frequent alcohol binges shift behavior from goal-directed to habitual processing modes. This shift in reward-associated learning strategies plays a key role in the development and maintenance of alcohol use disorders and seems to persist during (early stages of) sobriety in at-risk drinkers. Yet [...] Read more.
Frequent alcohol binges shift behavior from goal-directed to habitual processing modes. This shift in reward-associated learning strategies plays a key role in the development and maintenance of alcohol use disorders and seems to persist during (early stages of) sobriety in at-risk drinkers. Yet still, it has remained unclear whether this phenomenon might be associated with alcohol hangover and thus also be found in social drinkers. In an experimental crossover design, n = 25 healthy young male participants performed a two-step decision-making task once sober and once hungover (i.e., when reaching sobriety after consuming 2.6 g of alcohol per estimated liter of total body water). This task allows the separation of effortful model-based and computationally less demanding model-free learning strategies. The experimental induction of alcohol hangover was successful, but we found no significant hangover effects on model-based and model-free learning scores, the balance between model-free and model-based valuation (ω), or perseveration tendencies (π). Bayesian analyses provided positive evidence for the null hypothesis for all measures except π (anecdotal evidence for the null hypothesis). Taken together, alcohol hangover, which results from a single binge drinking episode, does not impair the application of effortful and computationally costly model-based learning strategies and/or increase model-free learning strategies. This supports the notion that the behavioral deficits observed in at-risk drinkers are most likely not caused by the immediate aftereffects of individual binge drinking events. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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14 pages, 475 KiB  
Article
The Impact of Alcohol Hangover on Simulated Driving Performance during a ‘Commute to Work’—Zero and Residual Alcohol Effects Compared
by Chris Alford, Callum Broom, Harriet Carver, Sean J. Johnson, Sam Lands, Rebecca Reece and Joris C. Verster
J. Clin. Med. 2020, 9(5), 1435; https://doi.org/10.3390/jcm9051435 - 12 May 2020
Cited by 24 | Viewed by 3317
Abstract
Driving is increasing across the world and road traffic accidents are a major cause of serious injuries and fatalities. The link between alcohol consumption and impaired driving has long been established and has led to legislation in many countries, with enforcement of legal [...] Read more.
Driving is increasing across the world and road traffic accidents are a major cause of serious injuries and fatalities. The link between alcohol consumption and impaired driving has long been established and has led to legislation in many countries, with enforcement of legal limits based on blood alcohol concentration levels. Alcohol hangover research is an emerging field with a range of laboratory and naturalistic studies now clearly demonstrating the significant impairments that can result from hangover, even when alcohol levels are measured at or close to zero the day following a social drinking occasion. Driving is a commonplace activity but requires competency with a range of complex and potentially demanding tasks. Driving impaired can have serious consequences, including death and serious injury. There have been only limited alcohol hangover driving studies. The studies presented examined the consequences of alcohol hangover with a driving simulator contrasting a group with zero residual alcohol (N = 26) next day and another with residual alcohol (N = 26) assessed with breathalyzer in the morning before undertaking a 20 min commute to work. All participants completed a morning drive after a night without alcohol consumption and another after a night of social drinking. The driving scenarios were relatively demanding including traffic and pedestrians, traffic lights and other potential hazards in a mixed rural and urban journey. Subjective hangover and workload were assessed in addition to a range of driving performance variables, including divided attention, steering control and driving violations. Analyses contrasted driving in the no alcohol condition with the residual alcohol condition. The combined groups data (N = 52) was contrasted with the zero and residual alcohol groups. Significant contrasts were found for a range of driving measures, including divided attention, vehicle control, and driving violations as well as perceived workload. The pattern of impairment was broadly similar across both groups, indicating that whether or not residual alcohol was present, consistent driving impairment was seen. The relatively high number of significant variables may reflect the increased cognitive demand of the 20 min commute drive including busy and complex urban environments. This was also reflected in the significant increase in perceived workload recorded across the 6 dimensions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Associations between subjective measures and driving performance with hangover suggested a potential lack of awareness of impairment, though were limited in number. The overall findings indicate that the levels of impairment seen reflect those seen with alcohol impaired driving, even when breath alcohol is zero. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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12 pages, 965 KiB  
Article
Alcohol Hangover and Multitasking: Effects on Mood, Cognitive Performance, Stress Reactivity, and Perceived Effort
by Sarah Benson, Elizabeth Ayre, Harriet Garrisson, Mark A Wetherell, Joris C Verster and Andrew Scholey
J. Clin. Med. 2020, 9(4), 1154; https://doi.org/10.3390/jcm9041154 - 17 Apr 2020
Cited by 10 | Viewed by 3929
Abstract
The aim of this study was to examine the effects of hangover on mood, multitasking ability, and psychological stress reactivity to cognitive demand. Using a crossover design and semi-naturalistic methodology, 25 participants attended the laboratory in the morning following a night of (i) [...] Read more.
The aim of this study was to examine the effects of hangover on mood, multitasking ability, and psychological stress reactivity to cognitive demand. Using a crossover design and semi-naturalistic methodology, 25 participants attended the laboratory in the morning following a night of (i) alcohol abstinence and (ii) alcohol self-administration during a typical night out (with order counterbalanced across participants). They completed a four-module multitasking framework (MTF, a widely used laboratory stressor) and a battery of questionnaires assessing mood, hangover symptom severity, and previous night’s sleep. The effects of the MTF on mood and perceived workload were also assessed. Participants in the hangover condition reported significantly lower alertness and contentment coupled with a higher mental fatigue and anxiety. Multitasking ability was also significantly impaired in the hangover condition. Completion of the cognitive stressor increased reported levels of mental demand, effort, and frustration, and decreased perceived level of performance. MTF completion did not differentially affect mood. Lastly, participants rated their sleep as significantly worse during the night prior to the hangover compared with the control condition. These findings confirm the negative cognitive and mood effects of hangover on mood. They also demonstrate that hangover is associated with greater perceived effort during task performance. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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15 pages, 1077 KiB  
Article
The Effects of Alcohol Hangover on Executive Functions
by Craig Gunn, Graeme Fairchild, Joris C. Verster and Sally Adams
J. Clin. Med. 2020, 9(4), 1148; https://doi.org/10.3390/jcm9041148 - 17 Apr 2020
Cited by 8 | Viewed by 7634
Abstract
Recent research has suggested that processes reliant on executive functions are impaired by an alcohol hangover, yet few studies have investigated the effect of hangovers on core executive function processes. Therefore, the current study investigated the effect of hangovers on the three core [...] Read more.
Recent research has suggested that processes reliant on executive functions are impaired by an alcohol hangover, yet few studies have investigated the effect of hangovers on core executive function processes. Therefore, the current study investigated the effect of hangovers on the three core components of the unity/diversity model of executive functions: the ability to switch attention, update information in working memory, and maintain goals. Thirty-five 18-to-30-year-old non-smoking individuals who reported experiencing a hangover at least once in the previous month participated in this study. They completed tasks measuring switching (number-switching task), updating (n-back task), and goal maintenance (AX Continuous Performance Test, AX-CPT) whilst experiencing a hangover and without a hangover in a ‘naturalistic’ within-subjects crossover design. Participants made more errors in the switching task (p = 0.019), more errors in both the 1- (p < 0.001) and 2-back (p < 0.001) versions of the n-back, and more errors in the AX-CPT (p = 0.007) tasks when experiencing a hangover, compared to the no-hangover condition. These results suggest that an alcohol hangover impairs core executive function processes that are important for everyday behaviours, such as decision-making, planning, and mental flexibility. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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13 pages, 276 KiB  
Article
The Effects of Alcohol Hangover on Mood and Performance Assessed at Home
by Chris Alford, Zuzana Martinkova, Brian Tiplady, Rebecca Reece and Joris C. Verster
J. Clin. Med. 2020, 9(4), 1068; https://doi.org/10.3390/jcm9041068 - 09 Apr 2020
Cited by 13 | Viewed by 3347
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
11 pages, 344 KiB  
Article
The Effects of SJP-001 on Alcohol Hangover Severity: A Pilot Study
by Joris C Verster, Thomas A Dahl, Andrew Scholey and Jacqueline M Iversen
J. Clin. Med. 2020, 9(4), 932; https://doi.org/10.3390/jcm9040932 - 31 Mar 2020
Cited by 7 | Viewed by 3970
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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5 pages, 197 KiB  
Communication
Updating the Definition of the Alcohol Hangover
by Joris C. Verster, Andrew Scholey, Aurora J.A.E. van de Loo, Sarah Benson and Ann-Kathrin Stock
J. Clin. Med. 2020, 9(3), 823; https://doi.org/10.3390/jcm9030823 - 18 Mar 2020
Cited by 54 | Viewed by 7323
Abstract
In 2016, the Alcohol Hangover Research Group defined the alcohol hangover as “the combination of mental and physical symptoms experienced the day after a single episode of heavy drinking, starting when blood alcohol concentration (BAC) approaches zero”. In the light of new findings [...] Read more.
In 2016, the Alcohol Hangover Research Group defined the alcohol hangover as “the combination of mental and physical symptoms experienced the day after a single episode of heavy drinking, starting when blood alcohol concentration (BAC) approaches zero”. In the light of new findings and evidence, we carefully reviewed the different components of that definition. Several studies demonstrated that alcohol hangovers are not limited to heavy drinking occasions. Instead, data from both student and non-student samples revealed that at a group level, alcohol hangover may occur at much lower BAC levels than previously thought. Regression analysis further revealed that for individual drinkers, the occurrence of hangovers is more likely when subjects consume more alcohol than they usually do. However, hangovers may also occur at a drinker’s usual BAC, and in some cases even at lower BAC (e.g. in case of illness). We also carefully reviewed and modified other parts of the definition. Finally, hangovers are not necessarily limited to the ‘next day’. They can start at any time of day or night, whenever BAC approaches zero after a single dinking occasion. This may also be on the same day as the drinking occasion (e.g. when drinking in, or until the morning and subsequently having a hangover in the afternoon or evening). To better reflect the new insights and sharpen the description of the concept, we hereby propose to update the definition of the alcohol hangover as follows: “The alcohol hangover refers to 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”, and recommend to use this new definition in future hangover research. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
17 pages, 2350 KiB  
Article
Alcohol Hangover Differentially Modulates the Processing of Relevant and Irrelevant Information
by Antje Opitz, Christian Beste and Ann-Kathrin Stock
J. Clin. Med. 2020, 9(3), 778; https://doi.org/10.3390/jcm9030778 - 12 Mar 2020
Cited by 4 | Viewed by 2460
Abstract
Elevated distractibility is one of the major contributors to alcohol hangover-induced behavioral deficits. Yet, the basic mechanisms driving increased distractibility during hangovers are still not very well understood. Aside from impairments in attention and psychomotor functions, changes in stimulus-response bindings may also increase [...] Read more.
Elevated distractibility is one of the major contributors to alcohol hangover-induced behavioral deficits. Yet, the basic mechanisms driving increased distractibility during hangovers are still not very well understood. Aside from impairments in attention and psychomotor functions, changes in stimulus-response bindings may also increase responding to distracting information, as suggested by the theory of event coding (TEC). Yet, this has never been investigated in the context of alcohol hangover. Therefore, we investigated whether alcohol hangover has different effects on target-response bindings and distractor-response bindings using a task that allows to differentiate these two phenomena. A total of n = 35 healthy males aged 19 to 28 were tested once sober and once hungover after being intoxicated in a standardized experimental drinking setting the night before (2.64 gr of alcohol per estimated liter of body water). We found that alcohol hangover reduced distractor-response bindings, while no such impairment was found for target-response bindings, which appeared to be unaffected. Our findings imply that the processing of distracting information is most likely not increased, but in fact decreased by hangover. This suggests that increased distractibility during alcohol hangover is most likely not caused by modulations in distractor-response bindings. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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15 pages, 248 KiB  
Article
Pain Catastrophising Predicts Alcohol Hangover Severity and Symptoms
by Sam Royle, Lauren Owen, David Roberts and Lynne Marrow
J. Clin. Med. 2020, 9(1), 280; https://doi.org/10.3390/jcm9010280 - 20 Jan 2020
Cited by 9 | Viewed by 3378
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
7 pages, 647 KiB  
Communication
Sensitivity to Experiencing Alcohol Hangovers: Reconsideration of the 0.11% Blood Alcohol Concentration (BAC) Threshold for Having a Hangover
by Joris C. Verster, L. Darren Kruisselbrink, Karin A. Slot, Aikaterini Anogeianaki, Sally Adams, Chris Alford, Lizanne Arnoldy, Elisabeth Ayre, Stephanie Balikji, Sarah Benson, Gillian Bruce, Lydia E. Devenney, Michael R. Frone, Craig Gunn, Thomas Heffernan, Kai O. Hensel, Anna Hogewoning, Sean J. Johnson, Albertine E. van Lawick van Pabst, Aurora J.A.E. van de Loo, Marlou Mackus, Agnese Merlo, René J.L. Murphy, Lauren Owen, Emily O.C. Palmer, Charmaine J.I. van Rossum, Andrew Scholey, Chantal Terpstra, Vatsalya Vatsalya, Sterre A. Vermeulen, Michelle van Wijk and Ann-Kathrin Stockadd Show full author list remove Hide full author list
J. Clin. Med. 2020, 9(1), 179; https://doi.org/10.3390/jcm9010179 - 09 Jan 2020
Cited by 26 | Viewed by 4988
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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16 pages, 1594 KiB  
Article
Relationship between Alcohol Hangover and Physical Endurance Performance: Walking the Samaria Gorge
by Joris C Verster, Aikaterini Anogeianaki, Darren Kruisselbrink, Chris Alford and Ann-Kathrin Stock
J. Clin. Med. 2020, 9(1), 114; https://doi.org/10.3390/jcm9010114 - 31 Dec 2019
Cited by 18 | Viewed by 3385
Abstract
Alcohol hangover is a potentially debilitating state. Several studies have demonstrated that it does not seem to impair strength or short-term endurance, but its effects on continuous exercise performance/long-term endurance have never been investigated. Therefore, the aim of the current study was to [...] Read more.
Alcohol hangover is a potentially debilitating state. Several studies have demonstrated that it does not seem to impair strength or short-term endurance, but its effects on continuous exercise performance/long-term endurance have never been investigated. Therefore, the aim of the current study was to assess hiking performance of participants who walked the 15.8 km Samaria Gorge in Crete, Greece. Participants completed a survey in the morning before walking the Gorge, and in the afternoon after completion of the walk. Demographics, data on previous evening alcohol consumption, sleep, hangover symptoms, and walking performance were assessed. Data from N = 299 participants with a mean (SD) age of 38.9 (11.0) years were analyzed. N = 223 participants (74.6%) consumed alcohol the evening before walking the Samaria Gorge, and N = 176 (78.9%) of those reported a hangover. They consumed a mean (SD) of 3.0 (1.8) alcoholic drinks (10 g alcohol each) with a corresponding next-morning hangover severity of 4.6 (2.4) on a 0–10 scale. Participants with a hangover reported feeling significantly more exhausted after the walk compared to participants with no hangover. The groups did not significantly differ in duration of the walk, and the number and duration of breaks. Overall hangover severity, assessed either before, during, or after walking the Samaria Gorge was not significantly correlated with any walking outcome. In conclusion, hungover participants experienced significantly more exhaustion when performing physical activity at the same level as non-hungover participants. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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13 pages, 1649 KiB  
Article
Exacerbation of Hangover Symptomology Significantly Corresponds with Heavy and Chronic Alcohol Drinking: A Pilot Study
by Vatsalya Vatsalya, Hamza Z. Hassan, Maiying Kong, Bethany L. Stangl, Melanie L. Schwandt, Veronica Y. Schmidt-Teron, Joris C. Verster, Vijay A. Ramchandani and Craig J. McClain
J. Clin. Med. 2019, 8(11), 1943; https://doi.org/10.3390/jcm8111943 - 12 Nov 2019
Cited by 7 | Viewed by 3540
Abstract
Alcohol hangover is a combination of mental, sympathetic, and physical symptoms experienced the day after a single period of heavy drinking, starting when blood alcohol concentration approaches zero. How individual measures/domains of hangover symptomology might differ with moderate to heavy alcohol consumption and [...] Read more.
Alcohol hangover is a combination of mental, sympathetic, and physical symptoms experienced the day after a single period of heavy drinking, starting when blood alcohol concentration approaches zero. How individual measures/domains of hangover symptomology might differ with moderate to heavy alcohol consumption and how these symptoms correlate with the drinking markers is unclear. We investigated the amount/patterns of drinking and hangover symptomology by the categories of alcohol drinking. We studied males and females in three groups: 12 heavy drinkers (HD; >15 drinks/week, 34–63 years old (y.o.)); 17 moderate drinkers (MD; 5–14 drinks/week, 21–30 y.o.); and 12 healthy controls (social/light drinkers, SD; <5 drinks/week, 25–54 y.o.). Demographics, drinking measures (Timeline followback past 90 days (TLFB90), Alcohol Use Disorders Identification Test (AUDIT)), and alcohol hangover scale (AHS) were analyzed. Average drinks/day was 5.1-times greater in HD compared to MD. Average AHS score showed moderate incapacity, and individual measures and domains of the AHS were significantly elevated in HD compared to MD. Symptoms of three domains of the AHS (mental, gastrointestinal, and sympathetic) showed domain-specific significant increase in HD. A domain-specific relation was present between AUDIT and specific measures of AHS scores in HD, specifically with the dependence symptoms. Exacerbation in hangover symptomology could be a marker of more severe alcohol use disorder. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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14 pages, 410 KiB  
Article
The Association between Alcohol Hangover Frequency and Severity: Evidence for Reverse Tolerance?
by Joris C. Verster, Karin A. Slot, Lizanne Arnoldy, Albertine E. van Lawick van Pabst, Aurora J. A. E. van de Loo, Sarah Benson and Andrew Scholey
J. Clin. Med. 2019, 8(10), 1520; https://doi.org/10.3390/jcm8101520 - 21 Sep 2019
Cited by 16 | Viewed by 5350
Abstract
Although hangover is a common consequence of heavy alcohol consumption, the area is heavily under-researched. Hangover frequency is a potential predictor of future alcohol use disorder that may be affected by hangover severity, yet the relationship between hangover frequency and severity has not [...] Read more.
Although hangover is a common consequence of heavy alcohol consumption, the area is heavily under-researched. Hangover frequency is a potential predictor of future alcohol use disorder that may be affected by hangover severity, yet the relationship between hangover frequency and severity has not been investigated. Using different methodologies and assessment instruments, two surveys, and one naturalistic study collected data on hangover frequency, hangover severity, and alcohol consumption. The relationship between hangover frequency and severity was investigated via correlational analysis, considering potentially moderating variables including alcohol intake, estimated blood alcohol concentration, demographics, and personality characteristics. In all the three studies, a positive and significant association between hangover frequency and severity was found, which remained significant after correcting for alcohol intake and other moderating factors. These findings suggest that hangover severity increases when hangovers are experienced more frequently and may be driven by sensitization or reverse tolerance to this aspect of alcohol consumption. Future research should further investigate the relationship between hangover frequency and severity and alcohol use disorder and its implications for prevention. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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16 pages, 1658 KiB  
Article
Alcohol Hangover Slightly Impairs Response Selection but not Response Inhibition
by Antje Opitz, Jan Hubert, Christian Beste and Ann-Kathrin Stock
J. Clin. Med. 2019, 8(9), 1317; https://doi.org/10.3390/jcm8091317 - 27 Aug 2019
Cited by 12 | Viewed by 3674
Abstract
Alcohol hangover commonly occurs after an episode of heavy drinking. It has previously been demonstrated that acute high-dose alcohol intoxication reduces cognitive control, while automatic processes remain comparatively unaffected. However, it has remained unclear whether alcohol hangover, as a consequence of binge drinking, [...] Read more.
Alcohol hangover commonly occurs after an episode of heavy drinking. It has previously been demonstrated that acute high-dose alcohol intoxication reduces cognitive control, while automatic processes remain comparatively unaffected. However, it has remained unclear whether alcohol hangover, as a consequence of binge drinking, modulates the interplay between cognitive control and automaticity in a comparable way. Therefore, the purpose of this study was to investigate the effects of alcohol hangover on controlled versus automatic response selection and inhibition. N = 34 healthy young men completed a Simon Nogo task, once sober and once hungover. Hangover symptoms were experimentally induced by a standardized administration of alcoholic drinks (with high congener content) on the night before the hangover appointment. We found no significant hangover effects, which suggests that alcohol hangover did not produce the same functional deficits as an acute high-dose intoxication. Yet still, add-on Bayesian analyses revealed that hangover slightly impaired response selection, but not response inhibition. This pattern of effects cannot be explained with the current knowledge on how ethanol and its metabolite acetaldehyde may modulate response selection and inhibition via the dopaminergic or GABAergic system. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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17 pages, 1142 KiB  
Article
Dietary Nutrient Intake, Alcohol Metabolism, and Hangover Severity
by Joris C. Verster, Sterre A. Vermeulen, Aurora J. A. E. van de Loo, Stephanie Balikji, Aletta D. Kraneveld, Johan Garssen and Andrew Scholey
J. Clin. Med. 2019, 8(9), 1316; https://doi.org/10.3390/jcm8091316 - 27 Aug 2019
Cited by 9 | Viewed by 13877
Abstract
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 [...] Read more.
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 (rPB = −0.521) and zinc (rPB = −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 (rPB = −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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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18 pages, 1141 KiB  
Article
Sex Differences in the Presence and Severity of Alcohol Hangover Symptoms
by Albertine E. van Lawick van Pabst, Lydia E. Devenney and Joris C. Verster
J. Clin. Med. 2019, 8(6), 867; https://doi.org/10.3390/jcm8060867 - 17 Jun 2019
Cited by 30 | Viewed by 4329 | Correction
Abstract
Studies have demonstrated significant sex differences in alcohol intoxication effects. In contrast, the majority of studies on the alcohol hangover phase did not investigate sex differences. Therefore, the current study examined possible sex differences in the presence and severity of alcohol hangover symptoms. [...] Read more.
Studies have demonstrated significant sex differences in alcohol intoxication effects. In contrast, the majority of studies on the alcohol hangover phase did not investigate sex differences. Therefore, the current study examined possible sex differences in the presence and severity of alcohol hangover symptoms. Data from n = 2446 Dutch students (male = 50.7%, female = 49.3%) were analyzed. They reported the presence and severity of 22 hangover symptoms experienced after their past month heaviest drinking occasion. Subjects were categorized according to their estimated peak blood alcohol concentration (eBAC) and presence and severity of the hangover symptoms were compared between men and women. In the lowest eBAC group (0% ≤ eBAC < 0.08%), no significant sex differences were found. In the subsequent eBAC group (0.08% ≤ eBAC < 0.11%), severity of nausea was significantly higher in women than in men. In the third eBAC group (0.11% ≤ eBAC < 0.2%), women reported higher severity scores on nausea, tiredness, weakness, and dizziness than men. Men reported the presence of confusion significantly more often than women, and women reported the presence of shivering significantly more often than men. In the fourth eBAC group (0.2% ≤ eBAC < 0.3%), women reported higher severity scores on nausea and tiredness than men. In the highest eBAC group (0.3% ≤ eBAC < 0.4%), no significant sex differences were found. In conclusion, across the eBAC groups, severity scores of nausea and tiredness were higher in women than in men. However, albeit statistically significant, the observed sex differences in presence and severity of hangover symptoms were of small magnitude, and therefore, have little clinical relevance. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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14 pages, 1258 KiB  
Article
Sleep after Heavy Alcohol Consumption and Physical Activity Levels during Alcohol Hangover
by Lydia E. Devenney, Kieran B. Coyle, Thomas Roth and Joris C. Verster
J. Clin. Med. 2019, 8(5), 752; https://doi.org/10.3390/jcm8050752 - 27 May 2019
Cited by 29 | Viewed by 11607
Abstract
Alcohol consumption can negatively affect sleep quality. The current study examined the impact of an evening of alcohol consumption on sleep, and next day activity levels and alcohol hangover. n = 25 healthy social drinkers participated in a naturalistic study, consisting of an [...] Read more.
Alcohol consumption can negatively affect sleep quality. The current study examined the impact of an evening of alcohol consumption on sleep, and next day activity levels and alcohol hangover. n = 25 healthy social drinkers participated in a naturalistic study, consisting of an alcohol and alcohol-free test day. On both days, a GENEactiv watch recorded sleep and wake, and corresponding activity levels. In addition, subjective assessments of sleep duration and quality were made, and hangover severity, and the amount of consumed alcoholic beverages were assessed. Alcohol consumption was also assessed in real-time during the drinking session, using smartphone technology. The results confirmed, by using both objective and subjective assessments, that consuming a large amount of alcohol has a negative impact on sleep, including a significant reduction in objective sleep efficiency and significantly lower self-reported sleep quality. Activity levels during the hangover day were significantly reduced compared to the alcohol-free control day. Of note, next-morning retrospective alcohol consumption assessments underestimated real-time beverage recordings. In conclusion, heavy alcohol consumption impairs sleep quality, which is associated with increased next day hangover severity and reduced activity levels. The outcome of this study underlines that, in addition to retrospectively reported data, real-time objective assessments are needed to fully understand the effects of heavy drinking. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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11 pages, 679 KiB  
Article
Effects of Alcohol Hangover on Cognitive Performance: Findings from a Field/Internet Mixed Methodology Study
by Andrew Scholey, Sarah Benson, Jordy Kaufman, Chantal Terpstra, Elizabeth Ayre, Joris C. Verster, Cory Allen and Grant J. Devilly
J. Clin. Med. 2019, 8(4), 440; https://doi.org/10.3390/jcm8040440 - 30 Mar 2019
Cited by 21 | Viewed by 5964
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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Review

Jump to: Editorial, Research, Other

14 pages, 1621 KiB  
Review
The Role of Alcohol Metabolism in the Pathology of Alcohol Hangover
by Marlou Mackus, Aurora JAE van de Loo, Johan Garssen, Aletta D. Kraneveld, Andrew Scholey and Joris C. Verster
J. Clin. Med. 2020, 9(11), 3421; https://doi.org/10.3390/jcm9113421 - 25 Oct 2020
Cited by 43 | Viewed by 10305
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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13 pages, 1812 KiB  
Review
The Assessment of Overall Hangover Severity
by Joris C Verster, Aurora J.A.E. van de Loo, Sarah Benson, Andrew Scholey and Ann-Kathrin Stock
J. Clin. Med. 2020, 9(3), 786; https://doi.org/10.3390/jcm9030786 - 13 Mar 2020
Cited by 45 | Viewed by 6626
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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Other

10 pages, 236 KiB  
Perspective
Advantages and Limitations of Naturalistic Study Designs and Their Implementation in Alcohol Hangover Research
by Joris C. Verster, Aurora J. A. E. van de Loo, Sally Adams, Ann-Kathrin Stock, Sarah Benson, Andrew Scholey, Chris Alford and Gillian Bruce
J. Clin. Med. 2019, 8(12), 2160; https://doi.org/10.3390/jcm8122160 - 06 Dec 2019
Cited by 32 | Viewed by 5095
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Alcohol Hangover: Causes, Consequences, and Treatment)
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