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1.  Effectiveness of artichoke extract in preventing alcohol-induced hangovers: a randomized controlled trial 
Background
Extract of globe artichoke (Cynara scolymus) is promoted as a possible preventive or cure for alcohol-induced hangover symptoms. However, few rigorous clinical trials have assessed the effects of artichoke extract, and none has examined the effects in relation to hangovers. We undertook this study to test whether artichoke extract is effective in preventing the signs and symptoms of alcohol-induced hangover.
Methods
We recruited healthy adult volunteers between 18 and 65 years of age to participate in a randomized double-blind crossover trial. Participants received either 3 capsules of commercially available standardized artichoke extract or indistinguishable, inert placebo capsules immediately before and after alcohol exposure. After a 1-week washout period the volunteers received the opposite treatment. Participants predefined the type and amount of alcoholic beverage that would give them a hangover and ate the same meal before commencing alcohol consumption on the 2 study days. The primary outcome measure was the difference in hangover severity scores between the artichoke extract and placebo interventions. Secondary outcome measures were differences between the interventions in scores using a mood profile questionnaire and cognitive performance tests administered 1 hour before and 10 hours after alcohol exposure.
Results
Fifteen volunteers participated in the study. The mean number (and standard deviation) of alcohol units (each unit being 7.9 g, or 10 mL, of ethanol) consumed during treatment with artichoke extract and placebo was 10.7 (3.1) and 10.5 (2.4) respectively, equivalent to 1.2 (0.3) and 1.2 (0.2) g of alcohol per kilogram body weight. The volume of nonalcoholic drink consumed and the duration of sleep were similar during the artichoke extract and placebo interventions. None of the outcome measures differed significantly between interventions. Adverse events were rare and were mild and transient.
Interpretation
Our results suggest that artichoke extract is not effective in preventing the signs and symptoms of alcohol-induced hangover. Larger studies are required to confirm these findings.
PMCID: PMC280580  PMID: 14662662
2.  Validity of the Hangover Symptoms Scale: Evidence from an Electronic Diary Study 
Background
The Hangover Symptoms Scale (HSS) assesses the frequency of 13 symptoms experienced after drinking in the past year. Cross-sectional analyses in college drinkers showed preliminary evidence for the validity of the HSS (Slutske et al., 2003). The current investigation extended this work by examining the construct validity of the HSS in an ecological momentary assessment investigation.
Methods
Frequent drinkers (N = 404) carried electronic diaries to track their daily experiences over three weeks. Each morning, the diary assessed prior-night drinking behaviors, the presence of current hangover, and intensity of current headache and nausea.
Results
Adjusting for sex and body mass, the HSS significantly predicted diary endorsement of hangover (OR = 2.11, 95% CI = 1.78–2.49, p <.001). Participants who endorsed the HSS headache and nausea items were especially likely to report elevations of corresponding symptoms in diary records made the morning after drinking. HSS scores incrementally predicted hangover when the number of drinks consumed in the episode was covaried but did not moderate the relationship between the number of drinks and diary hangover reports.
Conclusions
The HSS appears to be a valid tool for hangover research. Higher HSS scores identify individuals who complain of “real world” hangovers and who may be especially likely to display particular symptoms after a night of drinking. Past hangovers predicted future hangovers, suggesting hangovers do not necessarily discourage or inhibit future drinking, at least across the several-week time interval studied here. There is a need to develop and evaluate complementary measures that can more directly index individual differences in hangover susceptibility in survey designs.
doi:10.1111/j.1530-0277.2011.01592.x
PMCID: PMC3197866  PMID: 21762183
hangover; symptoms; questionnaire; Hangover Symptoms Scale; ecological momentary assessment
3.  The Alcohol Hangover Research Group Consensus Statement on Best Practice in Alcohol Hangover Research 
Current drug abuse reviews  2010;3(2):116-126.
Alcohol-induced hangover, defined by a series of symptoms, is the most commonly reported consequence of excessive alcohol consumption. Alcohol hangovers contribute to workplace absenteeism, impaired job performance, reduced productivity, poor academic achievement, and may compromise potentially dangerous daily activities such as driving a car or operating heavy machinery. These socioeconomic consequences and health risks of alcohol hangover are much higher when compared to various common diseases and other health risk factors. Nevertheless, unlike alcohol intoxication the hangover has received very little scientific attention and studies have often yielded inconclusive results. Systematic research is important to increase our knowledge on alcohol hangover and its consequences. This consensus paper of the Alcohol Hangover Research Group discusses methodological issues that should be taken into account when performing future alcohol hangover research. Future research should aim to (1) further determine the pathology of alcohol hangover, (2) examine the role of genetics, (3) determine the economic costs of alcohol hangover, (4) examine sex and age differences, (5) develop common research tools and methodologies to study hangover effects, (6) focus on factor that aggravate hangover severity (e.g., congeners), and (7) develop effective hangover remedies.
PMCID: PMC3827719  PMID: 20712593
Alcohol hangover; methodology; guidelines; research
4.  The Incidence and Severity of Hangover the Morning after Moderate Alcohol Intoxication 
Addiction (Abingdon, England)  2008;103(5):10.1111/j.1360-0443.2008.02181.x.
Background
Differential propensity for hangover may play a role in determining individuals’ drinking practices so predictors of incidence and severity are needed.
Methods
Data were combined from three randomized crossover trials investigating the residual effects of heavy drinking on next-day performance. All 172 participants received either an alcoholic beverage (M=.115 g% breath alcohol concentration [BrAC]) or placebo matched on type and amount one night and a week later received the other beverage. Alcoholic beverages were vodka, bourbon or high alcohol beer. After each drinking session, following a 9-hour period for sleep and breakfast, participants completed questionnaire a hangover measure.
Results
No hangover was reported by 24% of participants, mild hangover by 44% and moderate hangover by 32%. Neither alcoholic beverage type nor participant characteristics (sex, age, drinking practices, tobacco use, or family history of alcohol problems) were associated with incidence of hangover.
Conclusion
The majority of people experienced mild to moderate hangover the morning after this level of intoxication. Further studies are required to investigate other hypothesized causes of variation in the propensity for hangover.
doi:10.1111/j.1360-0443.2008.02181.x
PMCID: PMC3864560  PMID: 18412754
hangover; heavy drinking; family history of alcohol problems
5.  Intoxication with Bourbon versus Vodka: Effects on Hangover, Sleep and Next-Day Neurocognitive Performance in Young Adults 
Background
This study assessed the effects of heavy drinking with high or low congener beverages on next-day neurocognitive performance, and the extent to which these effects were mediated by alcohol-related sleep disturbance or alcoholic beverage congeners, and correlated with the intensity of hangover.
Methods
Healthy heavy drinkers age 21–33 (n = 95) participated in two drinking nights after an acclimatization night. They drank to a mean of 0.11 g% BrAC on vodka or bourbon one night with matched placebo the other night, randomized for type and order. Polysomnography recordings were made overnight; self-report and neurocognitive measures were assessed the next morning.
Results
After alcohol, people had more hangover and more decrements in tests requiring both sustained attention and speed. Hangover correlated with poorer performance on these measures. Alcohol decreased sleep efficiency and REM sleep, and increased wake time and next-day sleepiness. Alcohol effects on sleep correlated with hangover but did not mediate the effects on performance. No effect of beverage congeners was found except on hangover severity, with people feeling worse after bourbon. Virtually no sex differences appeared.
Conclusions
Since drinking to this level affects complex cognitive abilities, safety could be affected, with implications for driving and for safety sensitive occupations. Congener content affects only how people feel the next day so does not increase risk. The sleep disrupting effects of alcohol did not account for the impaired performance so other mechanisms of effect need to be sought. Since hangover symptoms correlate with impaired performance, these might be contributing to the impairment.
doi:10.1111/j.1530-0277.2009.01116.x
PMCID: PMC3674844  PMID: 20028364
Hangover; polysomnography; neuropsychology; alcohol administration; congeners; residual alcohol effects
6.  Childhood IQ and life course socioeconomic position in relation to alcohol induced hangovers in adulthood: the Aberdeen children of the 1950s study 
Objective
To examine the association between scores on IQ tests in childhood and alcohol induced hangovers in middle aged men and women.
Design, Setting, and Participants
A cohort of 12 150 people born in Aberdeen (Scotland) who took part in a school based survey in 1962 when IQ test scores were extracted from educational records. Between 2000 and 2003, 7184 (64%) responded to questionnaire inquiries regarding drinking behaviour.
Main outcome measures
Self reported hangovers attributable to alcohol consumption on two or more occasions per month.
Results
Higher IQ scores at 11 years of age were associated with a lower prevalence of hangovers in middle age (ORper one SD advantage in IQ score; 95% CI: 0.80; 0.72, 0.89). This relation was little affected by adjustment for childhood indicators of socioeconomic position (0.82; 0.74, 0.91) but was considerably attenuated after control for adult variables (fully adjusted model: 0.89; 0.79, 1.01).
Conclusions
Higher childhood IQ was related to a lower prevalence of alcohol induced hangovers in middle aged men and women. The IQ‐hangover effect may at least partially explain the link between early life IQ and adult mortality. This being the first study to examine this relation, more evidence is required.
doi:10.1136/jech.2005.045039
PMCID: PMC2566055  PMID: 16973534
alcohol; binge drinking; hangover; IQ; socioeconomic position
7.  The Acute Hangover Scale: A New Measure of Immediate Hangover Symptoms 
Addictive behaviors  2006;32(6):1314-1320.
Purpose
No psychometrically established measure of acute hangover symptoms is published and available to use in experimental investigations. The present investigation combined data across three studies of residual alcohol effects to establish the properties of a new Acute Hangover Scale (AHS) based on symptoms supported in previous lab studies.
Methods
Professional mariners from a Swedish maritime academy (n = 54) and young adult students/recent graduates of urban U.S. universities (n = 135) participated in one of three within-subjects' studies of residual effects of heavy drinking (M = .114 g% breath alcohol concentration [BrAC]). All drank placebo one evening and alcoholic drinks another evening followed by an 8-hour sleep period before completing the AHS 10-20 min after awakening.
Results
The AHS showed excellent internal consistency reliability the morning after alcohol. The AHS mean score and each item were significantly affected by beverage but not demographics or typical drinking, supporting validity.
Conclusions
The AHS is a reliable and valid instrument for assessing acute hangover symptoms in experimental investigations of residual alcohol effects.
doi:10.1016/j.addbeh.2006.10.001
PMCID: PMC2853365  PMID: 17097819
Hangover; residual alcohol effects; psychometric; assessment
8.  Hangover Sensitivity after Controlled Alcohol Administration as Predictor of Post-College Drinking 
Journal of abnormal psychology  2011;121(1):270-275.
Introduction
Predicting continued problematic levels of drinking after the early 20’s could help with early identification of persons at risk. This study investigated whether hangover insensitivity could predict post-college drinking and problems beyond the variance due to drinking patterns.
Methods
In a preliminary study, 134 college seniors from a laboratory study of hangover (Time 1) were contacted and assessed 1–4 years (M = 2.3) later (Time 2). Hangover severity was studied after controlled alcohol administration to a specific dose while controlling sleep and environmental influences. Hangover severity at Time 1 was used to predict Time 2 drinking volume and problems while controlling for relevant demographics and Time 1 drinking volume.
Results
Hangover insensitivity at Time 1 tended to predict a clinical level of alcohol problems with a strong statistical effect. Hangover sensitivity also correlated positively with sensitivity to alcohol intoxication. Hangover severity did not predict future drinking volume.
Conclusions
Hangover insensitivity correlates with insensitivity to intoxication and might predict more serious alcohol problems in the future, suggesting that a future larger study is warranted. Hangover insensitivity could result from physiological factors underlying low sensitivity to alcohol or risk for alcoholism.
doi:10.1037/a0024706
PMCID: PMC4043292  PMID: 21859168
hangover; drinking quantity; drinking problems; college drinking; transitions; level of response
9.  Food Service Employee Alcohol Use, Hangovers and Norms During and After Work Hours 
Journal of substance use  2011;17(3):269-276.
Aims
This paper presents analyses of norms and behavior concerning drinking before, during, and after work hours among U.S. bar-restaurant chain employees, with a focus on hangovers at work and their correlates.
Methods
A mixed method approach combined qualitative analysis of 64 face-to-face interviews held with randomly chosen service, managerial and kitchen staff and quantitative analyses (including multivariable linear regression and bivariate analyses) of data drawn from 1,286 completed telephone surveys (response rate 68%) with 18–29 year old employees.
Results
Relatively few survey respondents reported past-year drinking in the hour prior to work (5%) or during work hours (2.7%), but extensive drinking in non- work hours (85.5%), and 36.5% of respondents reported coming to work with a hangover at least once. Correlates of hangover at work were past year intoxication and holding positive norms for hangovers. These findings were elaborated by interview data describing heavy drinking after work at nearby bars, restaurants and employee homes.
Conclusions
The findings illustrated that employee drinking during work hours was not normative. However, study results portrayed widely-shared norms for heavy drinking outside of work, with hangovers and related harms appearing as the primary work time repercussions of after-work alcohol consumption.
doi:10.3109/14659891.2011.580414
PMCID: PMC3405146  PMID: 22844225
Occupational alcohol use; food service workers; young adults
10.  A survey of energy drink consumption patterns among college students 
Nutrition Journal  2007;6:35.
Background
Energy drink consumption has continued to gain in popularity since the 1997 debut of Red Bull, the current leader in the energy drink market. Although energy drinks are targeted to young adult consumers, there has been little research regarding energy drink consumption patterns among college students in the United States. The purpose of this study was to determine energy drink consumption patterns among college students, prevalence and frequency of energy drink use for six situations, namely for insufficient sleep, to increase energy (in general), while studying, driving long periods of time, drinking with alcohol while partying, and to treat a hangover, and prevalence of adverse side effects and energy drink use dose effects among college energy drink users.
Methods
Based on the responses from a 32 member college student focus group and a field test, a 19 item survey was used to assess energy drink consumption patterns of 496 randomly surveyed college students attending a state university in the Central Atlantic region of the United States.
Results
Fifty one percent of participants (n = 253) reported consuming greater than one energy drink each month in an average month for the current semester (defined as energy drink user). The majority of users consumed energy drinks for insufficient sleep (67%), to increase energy (65%), and to drink with alcohol while partying (54%). The majority of users consumed one energy drink to treat most situations although using three or more was a common practice to drink with alcohol while partying (49%). Weekly jolt and crash episodes were experienced by 29% of users, 22% reported ever having headaches, and 19% heart palpitations from consuming energy drinks. There was a significant dose effect only for jolt and crash episodes.
Conclusion
Using energy drinks is a popular practice among college students for a variety of situations. Although for the majority of situations assessed, users consumed one energy drink with a reported frequency of 1 – 4 days per month, many users consumed three or more when combining with alcohol while partying. Further, side effects from consuming energy drinks are fairly common, and a significant dose effect was found with jolt and crash episodes. Future research should identify if college students recognize the amounts of caffeine that are present in the wide variety of caffeine-containing products that they are consuming, the amounts of caffeine that they are consuming in various situations, and the physical side effects associated with caffeine consumption.
doi:10.1186/1475-2891-6-35
PMCID: PMC2206048  PMID: 17974021
11.  Alcohol and energy drinks: a pilot study exploring patterns of consumption, social contexts, benefits and harms 
BMC Research Notes  2012;5:369.
Background
Young people around the world are increasingly combining alcohol with energy drinks (AEDs). However, as yet, limited research has been conducted examining this issue, particularly in terms of exploring patterns of consumption, social practices and the cultural contexts of AED consumption. We sought to understand how AEDs are used and socially constructed among young people.
Methods
We conducted 25 hours of observation in a variety of pubs, bars and nightclubs, as well as in-depth interviews with ten young people who regularly consumed AEDs during a session of alcohol use.
Results
In this pilot study, participants were highly organised in their AED consumption practices and reported rarely altering this routine. Some young people consumed upwards of eight AEDs on a typical night, and others limited their use to between three and five AEDs to avoid unpleasant consequences, such as sleep disturbances, severe hangovers, heart palpitations and agitation. Wakefulness and increased energy were identified as the primary benefits of AEDs, with taste, reduced and increased intoxication, and sociability reported as additional benefits. Young AED users were brand sensitive and responded strongly to Red Bull imagery, as well as discounted AEDs. Finally, some young people reported substituting illicit stimulants with energy drinks.
Conclusions
Combining energy drinks with alcohol is now a normalised phenomenon and an integral and ingrained feature of the night-time economy. Despite this, many young people are unaware of recommended daily limits or related harms. While some young people consume AEDs to feel less drunk (consistent with motivations for combining alcohol with illicit stimulants), others report using AEDs to facilitate intoxication. While preliminary, our findings have relevance for potential policy and regulatory approaches, as well as directions for future research.
doi:10.1186/1756-0500-5-369
PMCID: PMC3478984  PMID: 22824297
Alcohol; Energy drinks; Stimulant; Policy; Australia
12.  Enhancement of Alcohol Metabolism by Sprouted Peanut Extract in SD Rats 
Excessive ethanol intake is known to induce a number of physiological symptoms, including headache, dizziness and vertigo. In this study, we investigated the attenuation effect of sprouted peanut extract (SPE) on ethanol-induced hangover in male Sprague-Dawley rats. The animals were divided into five groups: the control group, which was administered ethanol only; the ethanol plus SPE experimental groups, which were administered ethanol and 100, 200, or 400 mg SPE/kg b.w.; and the positive control group, which was administered ethanol plus DAWN808®, a commercial product. SPE-suspended water was delivered to rats via gavage 15 h and 30 min before the administration of ethanol. Blood was collected from the tail 0, 1, 3, and 5 h after ethanol administration. The results showed that serum ethanol concentrations were significantly lower in SPE treated groups than in the control group. Furthermore, hepatic alcohol and acetaldehyde dehydrogenase activities were enhanced by SPE in a dose dependent manner. These results suggest that SPE could be useful in attenuating hangover after alcohol consumption.
doi:10.3746/pnf.2014.19.1.001
PMCID: PMC3999802  PMID: 24772402
sprouted peanut; hangover; alcohol metabolism; SD rat
13.  21st Birthday Drinking and Associated Physical Consequences and Behavioral Risks 
Twenty-first birthday celebrations often involve dangerously high levels of alcohol consumption, yet little is known about risk factors for excessive drinking on this occasion. Participants (N = 150) from a larger prospective study who consumed at least one drink during their celebration completed questionnaires and semi-structured interviews about their 21st birthday within four days after the event. Assessments were designed to characterize 21st birthday alcohol use, adjusted for alcohol content, as well as situational/contextual factors (e.g., celebration location, peer influence) that contribute to event-level drinking. Participants reported an average of 10.85 drinks (9.76 adjusted drinks), with experienced drinkers consuming significantly more than relatively naïve drinkers who had no previous binge or drunken episodes. Men consumed more drinks, whereas age of first drunken episode and heavier drinking during the 3-months preceding the 21st birthday predicted higher estimated blood alcohol concentrations (eBACs) on the 21st birthday. Celebrating in bars and engaging in birthday-specific drinking traditions (free drinks at bars) explained additional variance in 21st birthday eBACs. Both physical consequences (e.g., blacking out or having a hangover) and behavioral risks (e.g., sexually provocative behaviors) were prevalent and were predicted by higher eBACs. Together these findings indicate that 21st birthday celebrations are associated with heavy drinking and a variety of physical consequences and behavioral risks.
doi:10.1037/a0025209
PMCID: PMC3232305  PMID: 21895347
21st birthday; alcohol; alcohol-related problems; behavioral risk; physical consequences
14.  Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials 
BMJ : British Medical Journal  2005;331(7531):1515-1518.
Objective To assess the clinical evidence on the effectiveness of any medical intervention for preventing or treating alcohol hangover.
Data sources Systematic searches on Medline, Embase, Amed, Cochrane Central, the National Research Register (UK), and ClincalTrials.gov (USA); hand searches of conference proceedings and bibliographies; contact with experts and manufacturers of commercial preparations. Language of publication was not restricted.
Study selection and data extraction All randomised controlled trials of any medical intervention for preventing or treating alcohol hangover were included. Trials were considered if they were placebo controlled or controlled against a comparator intervention. Titles and abstracts of identified articles were read and hard copies were obtained. The selection of studies, data extraction, and validation were done independently by two reviewers. The Jadad score was used to evaluate methodological quality.
Results Fifteen potentially relevant trials were identified. Seven publications failed to meet all inclusion criteria. Eight randomised controlled trials assessing eight different interventions were reviewed. The agents tested were propranolol, tropisetron, tolfenamic acid, fructose or glucose, and the dietary supplements Borago officinalis (borage), Cynara scolymus (artichoke), Opuntia ficus-indica (prickly pear), and a yeast based preparation. All studies were double blind. Significant intergroup differences for overall symptom scores and individual symptoms were reported only for tolfenamic acid, γ linolenic acid from B officinalis, and a yeast based preparation.
Conclusion No compelling evidence exists to suggest that any conventional or complementary intervention is effective for preventing or treating alcohol hangover. The most effective way to avoid the symptoms of alcohol induced hangover is to practise abstinence or moderation.
PMCID: PMC1322250  PMID: 16373736
15.  Activation of brain NOP receptors attenuates acute and protracted alcohol withdrawal symptoms in the rat 
BACKGROUND
Alcohol withdrawal, refers to a cluster of symptoms that may occur from suddenly ceasing the use of alcohol after chronic or prolonged ingestion. These symptoms make alcohol abstinence difficult and increase the risk of relapse in recovering alcoholics. In previous studies, we demonstrated that treatment with N/OFQ significantly reduces alcohol consumption and attenuates alcohol-seeking behaviour induced by environmental conditioning factors or by stress in rats. In the present study we evaluated whether activation of brain NOP receptors may also attenuate alcohol withdrawal signs in rats.
METHODS
For this purpose animals were subjected to a 6 day chronic alcohol intoxication (by intragastric administration) and at 8, 10 and 12 hours following cessation of alcohol exposure they were treated intracerebroventricularly (ICV) with N/OFQ (0.0, 1.0 and 3.0 μg/rat). Somatic withdrawal signs were scored after ICV treatment. In a subsequent experiment, to evaluate N/OFQ effects on alcohol withdrawal-induced anxiety another group of rats was subjected to ethanol intoxication and after one week was tested for anxiety behavior in the elevated plus maze (EPM). In the last experiment an additional group of rats was tested for anxiety elicited by acute ethanol intoxication (hangover anxiety). For this purpose, animals received an acute dose (3.0 g/kg) of 20% alcohol and 12-h later were tested in the EPM following ICV N/OFQ (0.0, 1.0 and 2.0μg/rat).
RESULTS
Results showed that N/OFQ significantly reduced the expression of somatic withdrawal signs and reversed anxiety-like behaviors associated with both chronic and acute alcohol intoxication. N/OFQ did not affect anxiety scores in nondependent animals.
CONCLUSIONS
The present findings suggest that the N/OFQ-NOP receptor system may represent a promising target for the development of new treatments to ameliorate alcohol withdrawal symptoms.
doi:10.1111/j.1530-0277.2010.01392.x
PMCID: PMC3066303  PMID: 21223310
Nociceptin; Orphanin FQ; Alcoholism; Withdrawal; Anxiety
16.  Hangover headache. Prevalence: Vågå study of headache epidemiology 
The Journal of Headache and Pain  2004;5(3):181-187.
In Vågå, Norway, with 3907 inhabitants, there were 2075 18–65-year-old dalesmen available for the headache epidemiology study. A total of 1838 dalesmen (88.6%) were personally examined. However, due to uncertainty whether hangover headache could be incorporated, this part of the study was started at no. 500. Of the remaining 1338 dalesmen, 1122, i. e., 83.9%, were questioned about hangover headache. The parochial “drinking culture” could probably best be characterised as binge drinking and not as a constant, daily consumption. Inclusion criteria were: intoxication by alcohol; headache; and the headache manifesting itself more than three hours after the end of drinking. In the whole series, 714 dalesmen had experienced hangover headache (“delayed alcohol-induced headache”) during their lifetime (64%). This may be the best way to express hangover headache prevalence. Among those who had been “exposed to proper amounts of alcohol”, the prevalence was considerably higher: 88%. With the existing drinking pattern, hangover headache clearly dominated in males (M/F ratio: 1.50 vs. 0.72 in those without hangover headache (p<0.0005)). Consistency tests showed high Kappa values.
doi:10.1007/s10194-004-0098-6
PMCID: PMC3452173
Headache; Headache epidemiology; Hangover headache; Alcohol
17.  Interactions between migraine and tension-type headache and alcohol drinking, alcohol flushing, and hangover in Japanese 
The Journal of Headache and Pain  2012;13(2):137-145.
The aim of the study was to investigate associations between headache types and alcohol drinking, alcohol flushing, and hangover. Alcohol consumption is inhibited by the presence of inactive aldehyde dehydrogenase-2 (ALDH2) whose carriers are susceptible to alcohol flushing and hangovers. We conducted a cross-sectional study of the 2,577 subjects (men/women: 1,018/1,559) who reported having ever experienced headaches unrelated to common colds and alcohol hangovers among 5,408 (2,778/2,630) Tokyo health checkup examinees. We used a questionnaire inquiring about current and past facial flushing after drinking a glass of beer which identifies the presence of inactive ALDH2 with a sensitivity and specificity of approximately 90%. Based on ICHD-II criteria migraine was diagnosed in 419 (75/344) subjects, and tension-type headache (TTH) in 613 (249/364). We classified the headaches of the remaining 1,545 (694/851) of headaches sufferers into the category “other headaches (OH)”. The migraineurs drank alcohol less frequently than the subjects with TTH among current/past alcohol flushers and than the subjects with OH regardless of flushing category. No such difference in drinking frequency was observed between TTH and OH. Current/past flushers drank alcohol less frequently than never flushers, and the likelihood that male migraineurs would avoid alcohol drinking than men with TTH or OH was stronger among current/past flushers than among never flushers. Flushers and women were more susceptible to hangover than never flushers and men, respectively, regardless of headache type. Among never flushers, women with migraine were more susceptible to hangover than women with OH. The difference in alcohol sensitivity may partly explain less alcohol consumption by migraineurs.
doi:10.1007/s10194-011-0413-6
PMCID: PMC3274580  PMID: 22234728
Alcohol; Alcohol flushing; Aldehyde dehydrogenase-2; Hangover; Migraine; Tension-type headache
18.  Interactions between migraine and tension-type headache and alcohol drinking, alcohol flushing, and hangover in Japanese 
The Journal of Headache and Pain  2012;13(2):137-145.
The aim of the study was to investigate associations between headache types and alcohol drinking, alcohol flushing, and hangover. Alcohol consumption is inhibited by the presence of inactive aldehyde dehydrogenase-2 (ALDH2) whose carriers are susceptible to alcohol flushing and hangovers. We conducted a cross-sectional study of the 2,577 subjects (men/women: 1,018/1,559) who reported having ever experienced headaches unrelated to common colds and alcohol hangovers among 5,408 (2,778/2,630) Tokyo health checkup examinees. We used a questionnaire inquiring about current and past facial flushing after drinking a glass of beer which identifies the presence of inactive ALDH2 with a sensitivity and specificity of approximately 90%. Based on ICHD-II criteria migraine was diagnosed in 419 (75/344) subjects, and tension-type headache (TTH) in 613 (249/364). We classified the headaches of the remaining 1,545 (694/851) of headaches sufferers into the category “other headaches (OH)”. The migraineurs drank alcohol less frequently than the subjects with TTH among current/past alcohol flushers and than the subjects with OH regardless of flushing category. No such difference in drinking frequency was observed between TTH and OH. Current/past flushers drank alcohol less frequently than never flushers, and the likelihood that male migraineurs would avoid alcohol drinking than men with TTH or OH was stronger among current/past flushers than among never flushers. Flushers and women were more susceptible to hangover than never flushers and men, respectively, regardless of headache type. Among never flushers, women with migraine were more susceptible to hangover than women with OH. The difference in alcohol sensitivity may partly explain less alcohol consumption by migraineurs.
doi:10.1007/s10194-011-0413-6
PMCID: PMC3274580  PMID: 22234728
Alcohol; Alcohol flushing; Aldehyde dehydrogenase-2; Hangover; Migraine; Tension-type headache
19.  Use of alcohol and drugs by Norwegian employees: a pilot study using questionnaires and analysis of oral fluid 
Background
The use of alcohol and drugs may affect workplace safety and productivity. Little is known about the magnitude of this problem in Norway.
Methods
Employee recruitment methods with or without individual follow-up were compared. The employees filled in a questionnaire and provided a sample of oral fluid. Samples were analysed for alcohol, ethyl glucuronide (EtG; a biological marker of recent large alcohol intake), psychoactive medicinal drugs and illegal drugs.
Results
Participation rates with and without individual follow-up were 96% and 68%, respectively. Alcohol was negative (≤0.1 mg/ml) in all samples, but 21.0% reported the intake of alcohol during the last 24 h. EtG was positive (>2.2 ng/ml) in 2.1% of the samples. In-efficiency or hangover at work during the past year was reported by 24.3%, while 6.2% had been absent from work due to the use of alcohol. The combination of self-report and analytical testing indicated that medicinal or illegal drugs had been used during the last 48 h by 5.1% and 1.7% of the participants, respectively; while only 4.2% and 0.4% admitted the use in the questionnaire.
Conclusions
Self-reported data suggest that hangover after drinking alcohol appears to be the largest substance abuse problem at Norwegian workplaces, resulting in absence and inefficiency at work. Analysis of oral fluid revealed that the use of illegal drugs was more common than drinking alcohol before working or at the workplace. The analysis of oral fluid may be a valuable tool in obtaining additional information on alcohol and drug use compared to using questionnaires alone.
doi:10.1186/1745-6673-5-13
PMCID: PMC2907386  PMID: 20550667
20.  DRINKING TO GET DRUNK AMONG INCOMING FRESHMEN COLLEGE STUDENTS 
This study examined college freshmen who intentionally drink alcohol to get drunk (DTGD). Survey data from 307 incoming freshmen college students living in freshmen residence halls who reported drinking alcohol in the last 30 days were analyzed. The majority (76.9%) of these self-reported drinkers reported DTGD. Relative to other freshmen drinkers, those who reported DTGD were significantly more likely to have consumed alcohol before going out to a party or bar, participated in a drinking game, drank heavily on a non-school night but not on a school night, used liquor, used beer, combined alcohol and drugs, experienced a hangover, vomited, passed out, and/or blacked out. The associations support DTGD as a measure of pre-meditated, controlled, and intentional consumption of alcohol to reach a state of inebriation. Common intentional drunkenness as observed in this study population may have implications for college alcohol risk reduction programs.
doi:10.1080/19325037.2011.10599176
PMCID: PMC3577095  PMID: 23440674
college; alcohol; binge drinking; freshmen
21.  Examining the relationship between typical drinking behavior and 21st birthday drinking behavior among college students: implications for event-specific prevention 
Addiction (Abingdon, England)  2008;104(5):760-767.
Aims
The purpose of this research was to: (i) compare 21st birthday drinking with typical drinking; (ii) assess the prevalence of negative consequences and risk behaviors experienced during the 21st birthday week; and (iii) examine the role of typical drinking and 21st birthday drinking in explaining 21st birthday week negative consequences and risk behaviors.
Setting and participants
Participants (n = 306; 50% male) included college students turning 21 at a Midwestern public university in the United States.
Design and measurement
Approximately 1 week prior to their 21st birthday, students completed measures of typical past 3-month alcohol consumption via a web-based survey. Following their birthday, students (n = 296; 50% male) completed measures of 21st birthday week drinking as well as negative consequences and risk behaviors.
Findings
Findings indicated that students consumed considerably larger amounts of alcohol during the week of their 21st birthdays in comparison to typical weekly consumption. Additionally, students experienced a variety of negative consequences and risk behaviors during the week of their 21st birthday, including hangovers, vomiting and not remembering part of the previous evening. Negative binomial regression results indicated that those most likely to experience more negative consequences and risk behaviors associated with 21st birthday drinking were those who consumed heavy amounts of alcohol the week of their birthday, but who did not typically drink excessively.
Conclusions
Findings underscore the need to develop event-specific prevention approaches for occasions associated with extreme drinking and provide direction for considering who may be at greatest risk for problems associated with celebratory drinking.
doi:10.1111/j.1360-0443.2009.02518.x
PMCID: PMC2684626  PMID: 19344447
Alcohol; alcohol-related problems; college students; event-specific drinking; event-specific prevention; 21st birthday
22.  Use of alcohol and drugs among health professionals in Norway: a study using data from questionnaires and samples of oral fluid 
Working under the influence of drugs and/or alcohol may affect safety and job performance. However, the size of this possible problem among health professionals (HPs) is unknown. The aim of this study was threefold: (i) to analyze samples of oral fluid and self-reported data from questionnaires to investigate the prevalence of alcohol and drugs among a sample of HPs in Norway, (ii) to study self-reported absence from or impairment at work due to alcohol and/or drug use, and (iii) to examine whether such use and absence/impairment due to such use depend on socio-demographic variables.
A total of 916 of the 933 invited HPs from hospitals and pharmacies participated in the study (participation rate = 98.2%), and 81.1% were women. Associations were analyzed in bi-variate cross tables with Chi-square statistics to assess statistical significance.
Alcohol was not detected in any of the samples. Ethyl glucuronide, a specific alcohol metabolite, was found in 0.3% of the collected samples. Illicit drugs and medicinal drugs were identified in 0.6% and 7.3% of the samples, respectively. Both analytical results and self-reported use of alcohol and drugs during the past 12 months indicate that recent and past year alcohol and drug use was lower among HPs than among workers in other business areas in Norway, Europe and US. Nevertheless, several HPs reported absence from work due to alcohol (0.9%) and medicinal drug use (0.8%) during the past 12 months. A substantial part (16.7%) of the self-reported medicinal drug users reported absence from work because of use of medicinal drugs during the past 12 months, and more than 1/4 of those reported in-efficiency at work because of the use of medicinal drugs during the past 12 months. Reduced efficiency at work due to alcohol use during the past 12 months was reported by 12.2%.
This sample of HPs seldom used illicit drugs, few had a high level of alcohol consumption, and few tested positive for medicinal drugs. Absence or hangover related to the use of medicinal drugs or alcohol appeared to be a bigger issue than the acute intoxication or the use of illicit drugs.
doi:10.1186/1745-6673-9-8
PMCID: PMC3973962  PMID: 24612541
Ethanol; Illicit drugs; Medications; Prevalence; Psychoactive substances; Saliva; Self-report; Workplace drug testing
23.  Heavy Episodic Drinking: Determining the Predictive Utility of Five or More Drinks 
Although the heavy episodic drinking (HED) measure of 5+ drinks (sometimes 4+ for women) is used extensively, there is no empirical basis for the designation of 5 drinks as the threshold (vs. another threshold that may perform equally). The present study sought to determine the threshold for HED that maximally predicts proximal and distal adverse-drinking-related outcomes. Participants included 115 young adults (57% female; 96% Caucasian) who partook in an 8-week Internet survey that assessed daily drinking as well as next-day hangover; 10 months later, adverse outcomes (problem drinking, alcohol-related problems, maximum number of drinks, and drug use) were surveyed. Thresholds were computed, with a range from 1+ drinks to 15+ drinks, and outcomes were predicted from each threshold. Findings for hangover measures showed relatively good convergence across multiple indicators, with greatest prediction occurring at a threshold of 10+ drinks per occasion. Different thresholds were observed for long-term outcomes, with higher thresholds indicative of outcomes with greater severity. Although alternatives to HED, such as subjective effects and blood alcohol concentration, can indicate risky drinking, a threshold measure of HED may have advantages in terms of prevention and of intervention efforts.
doi:10.1037/0893-164X.22.1.68
PMCID: PMC2898719  PMID: 18298232
heavy episodic drinking; binge drinking; threshold; alcohol; measurement
24.  The kappa opioid receptor antagonist JDTic attenuates alcohol seeking and withdrawal anxiety 
Addiction Biology  2012;17(3):634-647.
The role of kappa-opioid receptors (KOR) in regulation of alcohol-related behaviors is not completely understood. For example, alcohol consumption has been reported to increase following treatment with KOR antagonists in rats, but was decreased in mice with genetic deletion of KOR. Recent studies have further suggested that KOR antagonists may selectively decrease alcohol self-administration in rats following a history of dependence. We assessed the effects of the KOR antagonist JDTic on alcohol self-administration, reinstatement of alcohol seeking induced by alcohol-associated cues or stress, and acute alcohol withdrawal-induced anxiety (“hangover anxiety”). JDTic dose-dependently reversed hangover anxiety when given 48 h prior to testing, a time interval corresponding to the previously demonstrated anxiolytic efficacy of this drug. In contrast, JDTic decreased alcohol self-administration and cue-induced reinstatement of alcohol seeking when administered 2 h prior to testing, but not at longer pretreatment times. For comparison, we determined that the prototypical KOR antagonist nor-BNI can suppress self-administration of alcohol at 2h pretreatment time, mimicking our observations with JDTic. The effects of JDTic were behaviorally specific, as it had no effect on stress-induced reinstatement of alcohol seeking, self administration of sucrose, or locomotor activity. Further, we demonstrate that at a 2h pretreatment time JDTic antagonized the antinociceptive effects of the KOR agonist U50,488H but had no effect on morphine-induced behaviors. Our results provide additional evidence for the involvement of KOR in regulation of alcohol-related behaviors and provide support for KOR antagonists, including JDTic, to be evaluated as medications for alcoholism.
doi:10.1111/j.1369-1600.2012.00455.x
PMCID: PMC3334348  PMID: 22515275
Alcoholism; Dynorphin; Ethanol; Reinstatement; Self-administration; Stress
25.  Alcohol consumption and self-reported (SF12) physical and mental health among working-aged men in a typical Russian city: a cross-sectional study 
Addiction (Abingdon, England)  2013;108(11):1905-1914.
Aim
To investigate the association between patterns of alcohol consumption and self-reported physical and mental health in a population with a high prevalence of hazardous drinking.
Design
Cross-sectional study of an age-stratified random sample of a population register.
Setting
The city of Izhevsk, The Russian Federation, 2008–09.
Participants
A total of 1031 men aged 25–60 years (68% response rate).
Measurements
Self-reported health was evaluated with the SF12 physical (PCS) and mental (MCS) component summaries. Measures of hazardous drinking (based on frequency of adverse effects of alcohol intake including hangover, excessive drunkenness and extended episodes of intoxication lasting 2 or more days) were used in addition to frequency of alcohol consumption and total volume of beverage ethanol per year. Information on smoking and socio-demographic factors were obtained.
Findings
Compared with abstainers, those drinking 10–19 litres of beverage ethanol per year had a PCS score 2.66 [95% confidence interval (CI) = 0.76; 4.56] higher. Hazardous beverage drinking was associated with a lower PCS score [mean diff: −2.95 (95% CI = −5.28; −0.62)] and even more strongly with a lower MCS score [mean diff: −4.29 (95% CI = −6.87; −1.70)] compared to non-hazardous drinkers, with frequent non-beverage alcohol drinking being associated with a particularly low MCS score [−7.23 (95% CI = −11.16; −3.29)]. Adjustment for smoking and socio-demographic factors attenuated these associations slightly, but the same patterns persisted. Adjustment for employment status attenuated the associations with PCS considerably.
Conclusion
Among working-aged male adults in Russia, hazardous patterns of alcohol drinking are associated with poorer self-reported physical health, and even more strongly with poorer self-reported mental health. Physical health appears to be lower in those reporting complete abstinence from alcohol compared with those drinking 10–19 litres per year.
doi:10.1111/add.12257
PMCID: PMC3992912  PMID: 23692519
Alcohol; mental health; physical health; quality of life; Russia; self-reported health; SF12

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