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Editorial: Can Hangover Immunity be Really Claimed?

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... Approximately 20-25% of alcohol consumers are classed as 'hangover resistant', in that they report no hangover symptoms after a night of heavy drinking [36]. Previous research shows that hangover resistance is tightly coupled to eBAC levels [37,38]. Clearly, the number of hangover resistance claims is highly dependent on the amount of alcohol consumed; as the more drinks are consumed (and the higher the eBAC), the less likely drinkers are to claim hangover resistance. ...
... Clearly, the number of hangover resistance claims is highly dependent on the amount of alcohol consumed; as the more drinks are consumed (and the higher the eBAC), the less likely drinkers are to claim hangover resistance. For example, with an eBAC level above 0.20%, only 8.1% of alcohol consumers claim hangover resistance [37]. ...
... In line with previous research, it was predicted that around 50% of the participants would have relatively low eBACs (e.g., < 0.08%) [37]. It was further predicted that higher eBACs will lead to a decrease of hangover resistance claims. ...
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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.
... Changes in neurotransmitters and mitochondrial dysfunction, as well as the congeners added to different types of drink may also have a role [16]. The presence and severity of a hangover have been linked to the level of prior consumption in some studies, with the proportion of hangover resistant participants reducing to closer to zero as consumption levels achieve 0.3-0.4% estimated BAC [17,18]. However, individual differences affecting metabolism, such as genetic variation in alcohol dehydrogenase, as well as personality and health status, reflect a wide range of reported symptoms and overall severity [13,16]. ...
... All participants reported zero alcohol consumption on their no alcohol nights before testing, and they reported consuming a mean (SD) of 16.9 (4.2) units (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], calculated using the UK National Health Service (NHS) website tool (available at: www.nhs.uk) to convert recorded drinks into standard UK units (1 unit = 10 mL, 8 g pure alcohol). This level of consumption is similar to those reported elsewhere including 13.5 standard drinks (10 g pure alcohol) reported in a recent Australian study [26] averaging 135 g pure alcohol, whilst for this study 16.9 units of 8 g/10 mL is also equivalent to averaging 135 g pure alcohol based on the UK definition. ...
... There were no other significant interactions or gender differences. An overall effect for alcohol was seen with response times for arrow flankers (F (1,18) Table 2. ...
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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.
... This threshold was based on a study by Chapman et al. [6] in which participants experienced hangovers at this BAC level. At first glance, observing drinking levels of student samples and corresponding average BACs [3,[7][8][9], the threshold seems well selected. However, a closer look at the data revealed that this threshold could well be an arbitrary one. ...
... However, a closer look at the data revealed that this threshold could well be an arbitrary one. Research on large Dutch and Canadian student samples [7,8] revealed that a substantial number of drinkers who did not reach the consensus BAC level of 0.11% still reported having a hangover. Other studies also confirmed this observation. ...
... Aggregating the data of these two studies [3,9] revealed that 20.5% of N = 2822 students who reported a hangover had an estimated BAC well below 0.11% the night before (see Figure 1). In each of these studies [3,[7][8][9], BAC was (retrospectively) estimated using a modified Widmark formula [10] based on self-reported alcohol consumption, and taking into account sex and body weight. [3] identified that 19.4% of N = 1833 students who had a hangover after their past month's heaviest drinking occasion had an estimated BAC below 0.11%. ...
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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.
... These observations are neither consistent with 'heavy drinking' in the definition of the alcohol hangover, nor with the binge drinking threshold suggested by the NIAAA. Surveys completed by large student samples from Canada (N = 5540) and The Netherlands (N = 6002) further confirmed that alcohol hangovers are reported across all BAC levels [6,7]. Thus, hangovers may occur at any reasonable BAC level, and are not limited to 'heavy' drinking only. ...
... Further, to more accurately reflect the day-to-day variability in the likelihood of developing a hangover despite more or less equal circumstances [8], we further propose to change 'experienced' into 'which can be experienced'. This also acknowledges the fact that about 10% to 20% of drinkers report not having a hangover, even after consuming large amounts of alcohol [6,7]. ...
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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.
... The mechanisms of hangover damage proposed above are further complicated by the fact that hangovers vary greatly between individuals and some may not experience them at all (Verster et al., 2014a). Further research is needed to determine exactly what this damage is and if the body's sensitivity or resistance to hangovers works to compound or remedy the problem. ...
... Further research is needed to determine exactly what this damage is and if the body's sensitivity or resistance to hangovers works to compound or remedy the problem. Recent investigations have suggested that there is individual variability to an individual's sensitivity to alcohol hangovers, with around 10% of drinkers reporting to be resistant to hangovers even after high levels of consumption (estimated BAC < 0.18%) (Kruisselbrink et al., 2017;Verster et al., 2014a). Further research into metabolism difference between hangover-sensitive and -resistant individuals could hold the key to revealing its underling mechanism. ...
Article
Hangovers represent a major source of distress to the individual and a huge source of economic loss to society. Hangovers and their associated problems have been recognised for thousands of years in both Western and Eastern cultures but only in recent years has there been any scientific research into their mechanisms and treatments. This small review contrasts Chinese and Western approaches to the question of hangovers. We also give an overview of recent research into the mechanisms that may underpin it, which may suggest new approaches to prevention or treatment of hangovers.
... For this study, two types of social drinkers were recruited: individuals who experience hangovers after a night of consuming alcohol (the hangover sensitive group, n = 17) and individuals who do not experience hangovers after a night of consuming alcohol (the hangover resistant group, n = 18). This distinction was made, since research showed that around 25% of drinkers claim to be hangover resistant [34][35][36][37], i.e., not experiencing a hangover despite consuming the same amount of alcohol as hangover sensitive drinkers. As it can be hypothesized that there are differential effects in the relationship between biomarker assessments and hangover severity, both hangover sensitive and hangover resistant drinkers were included in the current study. ...
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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.
... Whereas most drinkers experience hangovers after heavy drinking, approximately 10-25% of social drinkers claim to be hangover-resistant, despite consuming large quantities of alcohol [21][22][23][24]. The symptoms reported by these hangover-resistant drinkers, if any, tend to be limited to mild drowsiness-related descriptors [25]. ...
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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.
... Previous studies suggest that 25% of drinkers report not having hangovers, despite consuming large quantities of alcohol [17][18][19]. Directly comparing this subsample's characteristics with individuals who are susceptible to having hangovers may shed light on the pathology of the alcohol hangover. The reason why some individuals are less susceptible to having hangovers is currently unknown. ...
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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.
... One study induced hangovers experimentally [19] and reported no effect on switch costs, reflecting the additional time needed to switch attention to the new rule set. However, experimental hangover manipulations involve administering lower doses of alcohol than are typically consumed when drinking in everyday life [28], and this practice could influence the effects of a hangover [29]. Two naturalistic studies, which involve assessing the impact of hangovers experienced following real-life drinking, investigated the effects of a hangover on perseveration errors, which are erroneous responses made according to the previously correct rule or set, reflecting a switching failure. ...
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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.
... The alcohol hangover refers to the combination of mental and physical symptoms, experienced the day after a single episode of heavy drinking, starting when blood alcohol concentration approaches zero [3]. The number of people experiencing alcohol hangover is high, with studies reporting 78% and higher prevalence of alcohol induced hangover [4,5] including social/light, moderate, and heavy drinkers. Hangover symptoms can be severe enough to impair daily routine, reduce productivity, and cause other associated complications of alcohol consumption [6]. ...
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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.
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This paper describes the methodology of the Utrecht Student Survey. This online survey was conducted in June 2011 by 6002 students living in Utrecht, The Netherlands. The aim of the survey was to determine the potential impact of mixing alcoholic beverages with energy drinks on overall alcohol consumption and alcohol-related consequences. In contrast to most previous surveys conducted on this topic, the current survey used a more appropriate within-subject design, comparing the alcohol consumption of individuals who consume alcohol mixed with energy drinks on occasions. Specifically, a comparison was conducted to examine the occasions during which these individuals consume this mixture versus occasions during which they consume alcohol alone. In addition to energy drinks, the consumption of other non-alcoholic mixers was also assessed when combined with alcoholic beverages. Furthermore, the reasons for consuming energy drinks alone or in combination with alcohol were investigated, and were compared to reasons for mixing alcohol with other non-alcoholic beverages. Finally, personality characteristics and the level of risk-taking behavior among the individuals were also assessed to explore their relationship with alcohol consumption. The Utrecht Student Survey will be replicated in the USA, Australia, and the UK. Results will be pooled, but also examined for possible cross-cultural differences.
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To investigate predictors of hangover during a week of heavy drinking in young adults. Design Observational prospective study. A total of 112 young Danish tourists were interviewed on three occasions during their holiday. They completed the Acute Hangover Scale and answered questions about their alcohol consumption and rest duration. The incidence of hangover was analysed as the proportion of heavy drinkers (i.e. those reporting drinking more than 12 standard units of alcohol during the night before) scoring above the 90th percentile of light drinkers (i.e. those who had consumed fewer than seven standard units the night before). We estimated the course and predictors of hangover using random effects regression. The incidence of hangover was 68% after drinking more than 12 standard units in the whole sample. The severity of hangover increased significantly during a week of heavy drinking and there was a time x number of drinks interaction, indicating that the impact of alcohol consumed on hangover became more pronounced later in the week. Levels of drinking before the holiday did not predict hangover. Hangovers after heavy drinking during holidays appear to be related both to amount drunk and time into the holiday.
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To assess the incidence of hangover we: (1) reviewed the experimental and survey literature; (2) performed secondary analyses on two large population surveys; and (3) calculated the incidence of hangover among young adults participating in several randomized trials we conducted on the aftereffects of heavy drinking. Survey data included adults admitted for alcohol detoxification, community adults who ever got "tipsy" or "high", adolescents in high school who ever drank heavily, adults who drank heavily in the past 12 months, and university students. Most of the experimental trials brought participants to intoxication. The consistency of findings across study designs, populations, and referenced time period suggests that around 23% of the population may be resistant to hangover. Since propensity for hangover may affect drinking patterns, further research on the consequences and predictors of hangover insensitivity is warranted.
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In German-speaking countries, blood ethanol concentrations (BECs) are usually calculated using Widmark's equation. The distribution factor r of this equation is a correction factor needed to obtain a reduced body mass and corresponds to the ratio of total body water and blood water content. To enhance the reliability of Widmark's model equation, the body weight, body height, blood water content and total body water of 256 women and 273 men were measured. The ratio of body water to blood water ranged from 0.44 to 0.80 in women and from 0.60 to 0.87 in men. For both sexes equations were developed by multiple regression analysis which allow the determination of the individual, more realistic distribution factors rFI (for females) and rMI (for males) even when only body height and body weight are known. Drinking experiments revealed a clearly higher congruence of calculated and measured blood ethanol concentrations when rFI or rMI were used instead of rigid distribution factors, i.e. 0.6 for women and 0.7 for men with or without the assumption of a 10% so-called resorption deficit. Additionally, Widmark's equation in combination with rFI or rMI allows a more accurate prediction of blood ethanol concentrations than the equations of Watson and Ulrich.