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

The 2010 Alcohol Hangover Research Group consensus paper defined a cutoff blood alcohol concentration (BAC) of 0.11% as a toxicological threshold indicating that sufficient alcohol had been consumed to develop a hangover. The cutoff was based on previous research and applied mostly in studies comprising student samples. Previously, we showed that sensitivity to hangovers depends on (estimated) BAC during acute intoxication, with a greater percentage of drinkers reporting hangovers at higher BAC levels. However, a substantial number of participants also reported hangovers at comparatively lower BAC levels. This calls the suitability of the 0.11% threshold into question. Recent research has shown that subjective intoxication, i.e., the level of severity of reported drunkenness, and not BAC, is the most important determinant of hangover severity. Non-student samples often have a much lower alcohol intake compared to student samples, and overall BACs often remain below 0.11%. Despite these lower BACs, many non-student participants report having a hangover, especially when their subjective intoxication levels are high. This may be the case when alcohol consumption on the drinking occasion that results in a hangover significantly exceeds their “normal” drinking level, irrespective of whether they meet the 0.11% threshold in any of these conditions. Whereas consumers may have relative tolerance to the adverse effects at their “regular” drinking level, considerably higher alcohol intake—irrespective of the absolute amount—may consequentially result in a next-day hangover. Taken together, these findings suggest that the 0.11% threshold value as a criterion for having a hangover should be abandoned.

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Sex Differences in the Presence and Severity of Alcohol Hangover Symptoms

Journal of Clinical Medicine ◽

10.3390/jcm8060867 ◽

2019 ◽

Vol 8 (6) ◽

pp. 867 ◽

Cited By ~ 12

Author(s):

van Lawick van Pabst ◽

Devenney ◽

Verster

Keyword(s):

Sex Differences ◽

Alcohol Intoxication ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Small Magnitude ◽

Severity Scores ◽

Alcohol Hangover ◽

Peak Blood ◽

Drinking Occasion

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.

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Perceived Immune Fitness, Individual Strength and Hangover Severity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17114039 ◽

2020 ◽

Vol 17 (11) ◽

pp. 4039

Author(s):

Aurora J. A. E. van de Loo ◽

Nikki Kerssemakers ◽

Andrew Scholey ◽

Johan Garssen ◽

Aletta D. Kraneveld ◽

...

Keyword(s):

Immune Status ◽

Important Determinant ◽

Blood Alcohol Concentration ◽

Heavy Drinking ◽

Alcohol Concentration ◽

Convenience Sample ◽

Single Item ◽

Checklist Individual Strength ◽

Alcohol Hangover ◽

Drinking Occasion

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

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

Journal of Clinical Medicine ◽

10.3390/jcm9092823 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2823 ◽

Cited By ~ 1

Author(s):

Chantal Terpstra ◽

Andrew Scholey ◽

Joris C. Verster ◽

Sarah Benson

Keyword(s):

Alcohol Consumption ◽

Online Survey ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Negative Consequences ◽

Increased Risk ◽

Alcohol Hangover ◽

Total Body ◽

Answering Questions

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.

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

Journal of Clinical Medicine ◽

10.3390/jcm9113670 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3670

Author(s):

Joris C. Verster ◽

Lizanne Arnoldy ◽

Sarah Benson ◽

Andrew Scholey ◽

Ann-Kathrin Stock

Keyword(s):

Alcohol Consumption ◽

Research Group ◽

Blood Alcohol Concentration ◽

Physical Symptoms ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Single Episode ◽

10Th Anniversary ◽

Recent Advances ◽

Alcohol Hangover

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

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Correlation between blood alcohol concentration (BAC), breath alcohol concentration (BrAC) and psychomotor evaluation in a clinical monitored study of alcohol intake in Brazil

Alcohol ◽

10.1016/j.alcohol.2017.07.002 ◽

2018 ◽

Vol 66 ◽

pp. 15-20 ◽

Cited By ~ 4

Author(s):

Ana Paula Drummond-Lage ◽

Rodrigo Gomes de Freitas ◽

Gabriel Cruz ◽

Luigi Perillo ◽

Marco Antonio Paiva ◽

...

Keyword(s):

Alcohol Intake ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Breath Alcohol ◽

Breath Alcohol Concentration

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Updating the Definition of the Alcohol Hangover

Journal of Clinical Medicine ◽

10.3390/jcm9030823 ◽

2020 ◽

Vol 9 (3) ◽

pp. 823 ◽

Cited By ~ 15

Author(s):

Joris C. Verster ◽

Andrew Scholey ◽

Aurora J.A.E. van de Loo ◽

Sarah Benson ◽

Ann-Kathrin Stock

Keyword(s):

Blood Alcohol Concentration ◽

Heavy Drinking ◽

Physical Symptoms ◽

Time Of Day ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Single Episode ◽

New Findings ◽

Alcohol Hangover ◽

Definition Of

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.

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Cytokine Changes following Acute Ethanol Intoxication in Healthy Men: A Crossover Study

Mediators of Inflammation ◽

10.1155/2016/3758590 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

Sudan Prasad Neupane ◽

Andreas Skulberg ◽

Knut Ragnvald Skulberg ◽

Hans Christian D. Aass ◽

Jørgen G. Bramness

Keyword(s):

Alcohol Intake ◽

Blood Alcohol Concentration ◽

Serum Levels ◽

Alcohol Concentration ◽

High Dose ◽

Blood Alcohol ◽

Assessment Period ◽

Acute Ethanol ◽

Overnight Fasting ◽

The Impact

Alcohol is a known modulator of the innate immune system. Owing to the absence of human studies, alcohol’s effect on circulating cytokine profile remains unclear. We investigated the effect of acute high dose alcohol consumption on systemic cytokine release. After an overnight fasting, alcohol-experienced healthy male volunteers (N=20) aged 25–45 years were given oral ethanol in the form of vodka (4.28 mL/kg) which they drank over a period of 30 minutes reaching peak blood alcohol concentration of 0.12% (SD 0.028). Blood samples were obtained prior to alcohol intake as well as 2, 7, and 12 hours thereafter. Serum levels of the inflammatory cytokines IL-1β, IL-1Ra, IL-6, IL-10, IL-17, IFN-γ, MCP-1, and TNF-αwere determined by the multibead-based assay. Baseline cytokine levels were not related to BMI, hepatic parameters, electrolytes, glucose, or morning cortisol levels. Within 2 hours of alcohol intake, levels of IL-1Ra were elevated and remained so throughout the assessment period (pfor trend = 0.015). In contrast, the levels of the chemokine MCP-1 dropped acutely followed by steadily increasing levels during the observation period (p<0.001). The impact of sustained elevated levels of MCP-1 even after the clearance of blood alcohol content deserves attention.

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The Importance of Alcohol Testing by Gas Chromatography vs the Cordebard Classical Method Modified in the Medico Legal Investigation

Revista de Chimie ◽

10.37358/rc.18.9.6543 ◽

2018 ◽

Vol 69 (9) ◽

pp. 2407-2410

Author(s):

Dan Perju Dumbrava ◽

Carmen Corina Radu ◽

Sofia David ◽

Tatiana Iov ◽

Catalin Jan Iov ◽

...

Keyword(s):

Gas Chromatography ◽

Chromatographic Method ◽

Classical Method ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Technical Details ◽

Gas Chromatographic Method ◽

Alcohol Testing ◽

Living Person

Considering the growing number of requests from the criminal investigations authorities addressed to the institutions of legal medicine, testing of blood alcohol concentration both in the living person and in the corpse, we believe that a presentation of the two methods which are used in our country, is a topic of interest at present. The purpose of this article is to provide the reader with the technical details on how blodd alcohol concentration is realised by means of the gas chromatographic method and the classical one, (Cordebard modified by D. Banciu and I. Droc) respectively. Another purpose of this article is to also show, in a comparative way, the elements that make the gas chromatographic method superior to the former one.

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A Driving Simulator Study of the Performance Effects of Low Blood Alcohol Concentration

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193129604001817 ◽

1996 ◽

Vol 40 (18) ◽

pp. 943-946 ◽

Cited By ~ 2

Author(s):

R. Wade Allen ◽

Zareh Parseghian ◽

Anthony C. Stein

Keyword(s):

Divided Attention ◽

Driving Simulator ◽

Blood Alcohol Concentration ◽

Large Body ◽

Alcohol Concentration ◽

Blood Alcohol ◽

Performance Effects ◽

Driving Task ◽

Simulator Study ◽

And Performance

There is a large body of research that documents the impairing effect of alcohol on driving behavior and performance. Some of the most significant alcohol influence seems to occur in divided attention situations when the driver must simultaneously attend to several aspects of the driving task. This paper describes a driving simulator study of the effect of a low alcohol dose, .055 BAC (blood alcohol concentration %/wt), on divided attention performance. The simulation was mechanized on a PC and presented visual and auditory feedback in a truck cab surround. Subjects were required to control speed and steering on a rural two lane road while attending to a peripheral secondary task. The subject population was composed of 33 heavy equipment operators who were tested during both placebo and drinking sessions. Multivariate Analysis of Variance showed a significant and practical alcohol effect on a range of variables in the divided attention driving task.

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4. Are a Blood Alcohol Concentration of 256mg/dl and Minimal Signs of Impairment Reliable Indications of Alcohol Dependence?

Medicine Science and the Law ◽

10.1177/002580249403400316 ◽

1994 ◽

Vol 34 (3) ◽

pp. 265-270 ◽

Cited By ~ 1

Author(s):

A W Jones

Keyword(s):

Expert Witness ◽

Blood Alcohol Concentration ◽

Drunk Driving ◽

Alcohol Concentration ◽

Driving Under The Influence ◽

Blood Alcohol ◽

Lower Court ◽

Dna Profile ◽

Court Of Appeals ◽

Driving Scenario

This article describes a drink-driving scenario where a woman was apprehended for driving under the influence (DUI) with a blood alcohol concentration (BAC) of 256mg/dl1 The correctness of this result was vigorously challenged by a medical expert witness for the defence, who was actually a specialist in alcohol diseases. Despite reanalysis to confirm the BAC as well as a DNA profile to prove the identity of the blood specimen, the woman was acquitted of the charge of drunk driving by the lower court. However, she was subsequently found guilty in the High Court of Appeals with a unanimous decision and sentenced to four weeks imprisonment. This case report illustrates some of the problems surrounding the use of expert medical evidence by the defence to challenge the validity of the prosecution evidence based solely on a suspect's BAC. In situations such as these, an expert witness should be called by the prosecution to clarify and, if necessary, rebut medical and/or scientific opinions that might mislead the court and influence the outcome of the trial.

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