Alcohol hangovers are the most commonly reported negative consequence of heavy drinking. About 80% of drinkers acknowledge having experienced a hangover at least once during the past year [1
], a finding that is corroborated by clinical trials indicating that around 20% of drinkers are resistant to hangover [2
]. Alcohol hangovers are characterized by a feeling of general misery, and several symptoms such as headache, thirst, sleepiness, and concentration problems are commonly reported [3
The aftereffects of alcohol consumption experienced during hangover are often qualified as unpleasant and disabling. For example, subjects report missing classes, work, or other obligations due to hangovers, but also feelings of regret and mood changes may be the result of excessive alcohol consumption [3
]. Hence, there is a clear need for a treatment or cure that prevents or reduces hangovers. On the Internet, many cures are marketed, but a systematic literature search revealed that the efficacy of the vast majority of them has not been scientifically investigated [4
]. Up to now, most potential hangover cures have shown no effectiveness, whereas other cures reduced only some of the core symptoms of alcohol hangover. For example, tolfenamic acid reduced severity scores of headache and nausea but had no effect on being tired [6
]. Also, Opuntia ficus indica
significantly reduced nausea, lack of appetite, and dry mouth but did not reduce complaints of headache, weakness, and dizziness [7
The main reason for the absence of an effective hangover cure is that limited research has been devoted to elucidate the pathology of alcohol hangover [8
]. The research that has been conducted shows that alcohol hangover is not simply the equivalent of dehydration, but that other mechanisms, such as activation of the immune system, may play a role in the genesis of alcohol hangover [8
]. The partial improvement observed for tolfenamic acid (which inhibits prostaglandin synthesis) and Opuntia ficus indica
(which is thought to reduce the inflammatory response to stressful stimuli) supports a potential role of the immune system in the development of alcohol hangover symptoms. However, much more research is needed to understand the pathology of alcohol hangover and develop an effective treatment [3
Ethical concerns have been expressed concerning alcohol hangover research. For example, it has been argued that development of effective treatments for hangovers will result in increased alcohol consumption, due to the diminished negative consequences. There is, however, no scientific proof to support this assumption. Moreover, research showed that people generally do not adjust their drinking behavior after having experienced hangovers [11
For ages alcohol has been consumed by mankind, and the presence of hangovers was already reported more than 3000 years ago in ancient India. The Suśruta Samhitā, one of the oldest Ā
yurvedic medicinal writings, refers to “paramada
” when discussing alcohol hangover and reports on common hangover symptoms such as pain in the head and joints, loss of taste, and thirst [12
]. Alcohol hangovers have been reported ever since throughout history, and as long as alcohol consumption is allowed, it is unrealistic to assume that any behavioral intervention will prevent hangovers from happening. Statistics from a French website on alcohol hangovers (http://gueuledebois.info/
) confirm the need for information about hangovers and how to treat them. gives an overview of the daily number of visits of the website during a 3 months period.
Figure 1 Number of visits on a French website for alcohol hangover (http://gueuledebois.info/). Data are shown from October 1st 2011 to January 2nd 2012. Each peak corresponds to a Sunday. Note the large peak at New Years day. The peak at November 1st corresponds (more ...)
Each peak in the number of page views in corresponds to a Sunday. This is not surprising, given that the weekends, and especially Saturday evenings, are the most likely occasions of heavy drinking, which may result in a hangover the following day.
Although most people consume alcohol in moderation and do not regularly experience a hangover, the socioeconomic consequences of having a hangover are high [13
]. That is, absenteeism and presenteeism are common consequences of having a hangover, and reduced productivity and increased risk of injury when operating dangerous machinery may be the result [14
]. Also, while driving or flying when having a hangover, people put not only themselves at risk but also those who are surrounding them [17
]. Hence, there are a number of arguments that plea for development of an effective cure that reduces or prevents alcohol hangover effects.
is an example of such a newly developed hangover cure (see ). The product is currently sold in pharmacies by Deenox in France, and like many hangover cures it can also be ordered online. Instructions for using After-Effect©
are to take three capsules before alcohol consumption and 2 capsules after drinking, before going to bed. The ingredients of After-Effect©
comprise borage oil (gamma linolenic acid), fish oil (omega-3), vitamins B1, B6, and C, magnesium, Silybum marianum
(silymarin), and Opuntia ficus indica
. The rationale for the manufacturer to include these ingredients in After-Effect©
was based on the current available literature on hangover cures and their effectiveness in reducing hangover symptoms and on their potential mechanisms of action. Regarding Opuntia ficus indica
, it should be noted that After-Effect©
contains a polar extract, which is different from the apolar extract used by Wiese et al. [7
]. It is therefore unknown whether After-Effect©
will have similar beneficial effects on hangover such as described by Wiese et al. (i.e., reduced scores on nausea, dry mouth, and lack of appetite). summarizes the ingredients, suggested mechanism of action, and the corresponding hangover symptoms that showed to benefit from their use [18
After-Effect©: package and capsules. Three capsules should be taken before alcohol consumption and two additional capsules before going to bed.
Rationale for the ingredients included in After-Effect©.
reveals that there is scientific support showing that the individual ingredients of After-Effect©
can reduce several common hangover symptoms. However, their combined effect (i.e., the After-Effect©
formula) has not been scientifically investigated. Therefore, the objectives of the current study were to (1) examine the effectiveness of After-Effect©
and (2) to evaluate consumer satisfaction of this hangover aid. The design of the study followed a naturalistic approach [30
], which is quite common for consumer satisfaction studies [32
]. Participants consumed alcohol at a place, quantity, and time of their own preference without interference of the researchers. On that occasion, they also used After-Effect©
and completed a questionnaire the following day.