Editorial
Current Drug Abuse Reviews, 2013, Vol. 6, No. 4
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Editorial Can Hangover Immunity be Really Claimed? Joris C. Verster*,1,2,§, Suzanne de Klerk1, Adriana C. Bervoets1 and L. Darren Kruisselbrink3 1
Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
2
Centre for Human Psychopharmacology, Swinburne University, Melbourne VIC 3122, Australia
3
School of Recreation Management & Kinesiology, Acadia University, Canada
Next-day adverse effects of an evening of heavy alcohol consumption such as drowsiness, concentration problems, and headache are collectively called the alcohol hangover. The hangover state has serious socioeconomic consequences and may compromise daily activities such as driving a car [1]. It has been suggested that not experiencing alcohol hangovers, i.e. being hangover immune, may increase the risk of continuing harmful drinking behavior. From experimental data, Howland et al. estimated the incidence of hangover immunity around 25% of drinkers [2]. However, the peak blood alcohol concentration (BAC) achieved in these studies did not exceed 0.10-0.12%, which is lower than that observed in real life drinking sessions [3]. It is therefore unknown to what extent hangover immunity exists in real life, and to what extent this depends on the amount of alcohol consumed. Data from a large Dutch survey may [4] answer this question. As part of this survey, which was conducted among N=6002 Dutch students, data were obtained on the largest number of alcoholic drinks they consumed on one occasion in the past month, the time frame over which those drinks were consumed, and whether or not they experienced a hangover during the past year. For each drinker, the estimated BAC was calculated [5], and two analyses were performed. First, the percentage of subjects reporting no hangover was examined for different BAC levels. Second, a cumulative frequency distribution was constructed to examine the percentage of subjects not reporting a hangover at or below a certain estimated BAC. Data of N=5459 subjects (N=1927 men and N=3532 women) was included in the analyses, of which 32.1% reported having no hangovers. Estimated mean (SD) BAC on past month highest volume drinking episode was 0.14% (0.1). Fig. (1) shows that the higher their estimated BAC, the less likely it is that drinkers claim hangover immunity. More than half (53.8%) of drinkers who had not experienced a hangover in the past year had a BAC of 0.08% or less. The percentage decreases however rapidly with higher BACs, and above a BAC of 0.20% only 8.1% of drinkers reported to be hangover immune. 100 90
% immune to hangover
80 70 60 50 40 30 20 10 0 0
0,05 0,1 0,15 0,2 0,25 0,3 0,35 0,4 Estimated peak BAC (%) for highest volume drinking episode of past month
Fig. (1). Reported hangover immunity at different BAC levels. The percentage of hangover immune drinkers for different estimated BACs is shown.
Fig. (2) shows the cumulative percentage of hangover immune drinkers at or below a certain BAC. Almost half of drinkers claiming hangover immunity (40.7%) have an estimated BAC at or below 0.05%, and 59.3% have an estimated BAC at or below 0.08%, i.e. the legal limit for driving in USA and UK.
*Address correspondence to this author at the Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG, Utrecht, The Netherlands; Tel: +31 30 253 6909; Fax: +31 30 253 7900; E-mail:
[email protected] §
Editor-in-Chief
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Current Drug Abuse Reviews, 2013, Vol. 6, No. 4
Editorial
The data suggest that claiming hangover immunity depends heavily on the achieved peak BAC. The majority of those claiming to have no hangover had an estimated peak BAC below 0.08%. Taking into account that the current self-reported data has the usual limitations inherent to survey research [4], future studies should verify if hangover immunity can really be claimed, or that many of these drinkers simply do not consume sufficient amounts of alcohol to produce a hangover. Cummulative % of hangover immune drinkers
100 90 80 70 60 50 40 30 20 10 0 0 0,02 0,05 0,08 0,1 0,15 0,2 0,25 0,3 0,35 0,4 Estimated peak BAC (%) for highest volume drinking episode of past month
Fig. (2). The cumulative percentage of drinkers at or below a certain BAC who claim to have no hangover. BAC estimates were collapsed into 0.01% increments within a range of -0.0050 and +0.0049 around each increment. Above a BAC of 0.20%, number of subjects per 0.01% increment were lower and thus BAC estimates were grouped as BAC 0.21-0,25%, BAC 026-0,30%, BAC 0.31-0.35%, and BAC ≥ 0.36%.
ACKNOWLEDGMENTS The presented data are part of a survey that was supported by a grant from Red Bull. Red Bull was not involved in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Joris Verster has received grants / research support from The Dutch Ministry of Infrastructure and the Environment, Takeda, Red Bull, and has acted as a consultant for Canadian Beverage Association, Centraal Bureau Drogisterijbedrijven, Coleman Frost, Deenox, Purdue Pharma, Red Bull, Sanofi-Aventis, Sepracor, Takeda, Transcept, and Trimbos Institute. The other authors have no conflicts of interest to disclose. REFERENCES [1] [2] [3] [4] [5]
Verster JC, Stephens R, Penning R. On behalf of the Alcohol Hangover Research Group. The Alcohol Hangover Research Group consensus statement on best practice in alcohol hangover research. Curr Drug Abuse Rev 2010; 3: 116-27. Howland J, Rohsenow DJ, Edwards EM. Are some drinkers resistant to hangover: A literature review. Curr Drug Abuse Rev 2008; 1: 42-6. Hesse M, Tutenges S. Predictors of alcohol hangover during a week of heavy drinking on holiday. Addiction 2010; 105: 476-83. De Haan L, de Haan H, Olivier B, Verster JC. Alcohol Mixed With Energy Drinks: Methodology and Design of The Utrecht Student Survey. Int J Gen Med 2012; 5: 889-98. Seidl S, Jensen U, Alt A. The calculation of blood ethanol concentrations in males and females. Int J Legal Med 2000, 114: 71-7.
