Hangover Symptoms, Heavy Episodic Drinking, and Depression in Young Adults: A Cross-Lagged Analysis

The Relationship Between Alcohol Hangover Frequency and Hangover Severity

Objective: Tolerance to the acute effects of alcohol, i.e., feeling less intoxicated after consuming the same amount of alcohol, has been reported for individuals who regularly consume alcohol. In this study, it was investigated whether such tolerance also exists for experiencing the alcohol hangover. Methods: Data from five studies that assessed hangover frequency and hangover severity were combined (n = 924). Partial correlations were computed between hangover frequency and hangover severity, with age, sex, and weekly alcohol consumption as possible confounders. Results: A significant and positive correlation was found between hangover frequency and hangover severity (r = 0.692, p < 0.001). After correcting for sex, age, and weekly alcohol consumption, the partial correlation remained significant (r = 0.526, p < 0.001). Conclusions: The observed positive association between hangover frequency and hangover severity suggests a reverse tolerance: if hangovers are experienced more frequently, they are more severe.

Predictors of Hangover Frequency and Severity: The Impact of Alcohol Consumption, Mental Resilience, Personality, Lifestyle, Coping and Mood

Mental resilience is the ability to bounce back from daily life stressors such as divorce or losing a job. Extensive research has demonstrated a negative relationship between mental resilience and alcohol consumption. That is, both the quantity and frequency of alcohol consumption are greater in individuals with lower levels of mental resilience. There has, however, been little scientific attention paid to the relationship between mental resilience and alcohol hangover severity. The objective of this study was to evaluate psychological factors that may impact the frequency and severity of alcohol hangovers, including alcohol intake itself, mental resilience, personality, baseline mood, lifestyle, and coping mechanisms. An online survey was conducted among Dutch adults (N = 153) who had a hangover after their heaviest drinking occasion in the period before the start of the COVID-19 pandemic (15 January to 14 March 2020). Questions were asked about their alcohol consumption and hangover severity on their heaviest drinking occasion. Mental resilience was assessed with the Brief Mental Resilience scale, personality with the Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RSS), mood via single item assessments, and lifestyle and coping with the modified Fantastic Lifestyle Checklist. The partial correlation, corrected for estimated peak blood alcohol concentration (BAC), between mental resilience and hangover severity was not significant (r = 0.010, p = 0.848). Furthermore, no significant correlations were found between hangover severity or frequency and personality and baseline mood. For lifestyle and coping factors, a negative correlation was found between the use of tobacco and toxins (i.e., drugs, medicines, caffeine) and the frequency of experiencing hangovers. Regression analysis revealed that hangover severity after the heaviest drinking occasion (31.2%) was the best predictor of hangover frequency, and that subjective intoxication on the heaviest drinking occasion (38.4%) was the best predictor of next-day hangover severity. Mood, mental resilience, and personality were not relevant predictors of hangover frequency and severity. In conclusion, mental resilience, personality, and baseline mood do not predict hangover frequency and severity.

Blackouts and hangover experiences among Hispanic and Non-Hispanic White college students

Blackouts and hangovers may negatively impact college students' health and productivity. However, few studies have considered the impact of cultural differences on students' individual experiences with blackouts and hangovers. To address this issue, the current study explored the potential relationships of shame and resilience with Hispanic (n = 381) and non-Hispanic White (NHW, n = 332) students' self-reported blackouts and hangover experiences. Students completed an online survey measuring shame, resilience, presence of lifetime blackout experiences preceding a hangover, and past-year hangover severity. Analyses included separate path models examining shame and resilience, and the interaction between shame and resilience with Hispanic ethnicity in relation to blackouts and hangover experiences. Significant pathways emerged between resilience, but not shame, and blackouts and hangover experiences. A subscale of resilience reflecting personal competence and tenacity was related to greater likelihood of reporting blackouts and greater hangover severity for Hispanics but not NHW students. Conversely, a dimension of resilience characterized by trusting one's instincts and tolerance of negative affect was related to a lower likelihood of reporting a blackout preceding a hangover for Hispanics but not NHW students. Finally, a resilience subscale associated with spiritual influences was positively related to blackouts in the participant population as a whole. These results reinforce the notion that resilience is an important target for intervention and prevention of hazardous drinking, but reveal that it may have both positive and negative effects in college students, which may differ by ethnicity.

Indirect and direct effects of simultaneous alcohol and cannabis use on alcohol hangovers

INTRODUCTION

Simultaneous use of alcohol and cannabis (i.e., using both on same occasion) is a risk factor for heavier drinking and negative alcohol consequences; however, little research has investigated risk conferred for specific negative consequences. One theoretically relevant negative consequence may be alcohol hangovers; however, no studies have tested cross-sectional or prospective relations between simultaneous use and experiencing alcohol hangovers.

METHOD

The current study (N = 2,964) used public-access data from the National Longitudinal Study on Adolescent to Adult Health (Add Health) to test whether simultaneous alcohol and cannabis use conferred risk for hangover frequency directly or indirectly through heavier drinking. The current study also tested moderated mediation by depressive symptoms, considering simultaneous users have higher levels of depressive symptoms, and depressive symptoms largely mirror those of a hangover.

RESULTS

In a cross-sectional model, simultaneous use was associated with more frequent hangovers both directly and indirectly through heavier drinking. In a prospective model, simultaneous use indirectly predicted more frequent hangovers through heavier drinking; however, the direct path was not significant. None of the paths from simultaneous use to drinking or hangovers were moderated by depressive symptoms in either model.

CONCLUSIONS

The current study suggests that, both concurrently and prospectively, heavier drinking explained significant variance in the relation between simultaneous use and hangover frequency. The significant direct effect of simultaneous use in the cross-sectional model suggests that simultaneous users may have individual characteristics, outside of depressive symptoms, that confer risk for more frequent hangovers above and beyond heavier drinking.

Associations between Mental Resilience, Mood, Coping, Personality, and Hangover Severity

Extensive research exists on relationships between psychological constructs and alcohol consumption. However, research on relationships with hangover severity remains limited. This study aimed to assess the associations between mental resilience, mood (i.e., depression, anxiety, and stress), coping, personality, and hangover severity. A total of N = 690 participants completed an online survey by answering questions regarding their demographics, alcohol use, hangover prevalence and severity, and several psychological assessments (Brief Resilience Scale, DASS-21, Brief Cope, and Brief Version of the Big Five Personality Inventory). Significant associations were found between hangover severity and mental resilience, mood, and avoidant coping. Higher levels of mental resilience were associated with less severe hangovers, whereas poorer mood was associated with more severe hangovers. No significant associations were found with personality traits. These findings demonstrate that several associations between psychological constructs and hangover severity exist and suggest a role of psychological factors in the pathology of the alcohol hangover. As our findings contrast with the results of previous studies that did not report an association between mental resilience and the presence and severity of hangovers, further research is warranted.

The relationship between perceived social support and psychological distress in carers of older relatives: A longitudinal cross-lagged analysis

BACKGROUND AND OBJECTIVES

Although a large body of research has examined the relationship between social support and psychological health of family carers of frail older people, the exact nature and direction of this relationship is not well understood with most research to date being cross-sectional. This longitudinal study explored the relationship between perceived social support and psychological distress in carers of older relatives.

METHODS

We used data from two longitudinal cohorts which included a total of 332 family carers of frail older people. We used cross-lagged panel analysis to investigate the longitudinal association between perceived social support and carer psychological distress controlling for a number of covariates over time.

RESULTS

Fully-adjusted Generalised Estimating Equations (GEE) and cross-lagged models indicated that higher social support was significantly associated with lower carer psychological distress over time (regression coefficient [B] = -0.178, standard error [SE] = 0.028), with levels of perceived social support exerting an effect on psychological distress rather than vice versa (β = 0.03, p = 0.32).

LIMITATIONS

All observations were based on self-report data, and there may be other variables that may explain the results that we did not account for.

DISCUSSION AND IMPLICATIONS

Our study finds that the directionality of the relationship appears to be from perceived social support to carer psychological distress suggesting that social support directly affects carer psychological health but not vice versa. This finding has important implications for the provision of social support interventions for carers of frail older people at risk of experiencing psychological distress.

Daily experiences of hangover severity and food consumption in young adults

OBJECTIVES

Our aim was to determine whether alcohol hangover is associated with eating unhealthy foods (hot chips, soft drink) or healthy foods (fruit, vegetables).

DESIGN

Daily diary study across 13 days (micro-longitudinal design).

METHODS

We examined a sample of 605 young adults (71% women; ages 17-25; mean age 19.91 [SD 1.86] years) who completed daily diaries in the university community and reported drinking alcohol at least twice during the 13-day study period. Each day, participants reported on their hangover severity, their consumption of fruit, vegetables, hot chips (French fries), and soft drink, and their alcohol consumption from the previous day. Linear mixed models were used to examine within-person associations between hangover severity and food consumption, by gender. Exploratory models also controlled for previous day alcohol consumption to acknowledge potential variability in hangover susceptibility.

RESULTS

On days when participants reported higher severity of hangovers, they reported consuming more hot chips (β = .09, p = .001), more soft drink (β = .08, p = .001) and less fruit (β = -.06, p = .05). In our exploratory model controlling for previous day alcohol consumption, the predictive effect of hangover severity on hot chips remained (β = .08, p = .009) and significant interaction effects were observed between gender and previous day alcohol consumption on fruit (β = -.03, p = .003) and vegetable (β = -.03, p = .03) servings.

CONCLUSIONS

Higher hangover severity may lead to greater intake of some unhealthy foods such as hot chips, an effect that may not be reduceable to those associated with alcohol consumption per se. Interventions that target excessive drinking primarily, but also emphasize the importance of a healthy diet, should be considered for this population.

The Impact of Mood and Subjective Intoxication on Hangover Severity

The aim of this study was to investigate whether baseline mood and/or mood while drinking have an impact on alcohol hangover severity. A survey was held among N = 331 young adults (mean age = 23.6 years, range = 18-35 years). Demographics, alcohol consumption, subjective intoxication, and hangover severity were assessed for the past three days. In addition, mood (baseline, while drinking, and during hangover) was also assessed. N = 143 participants reported to be hungover on the day of assessment, N = 122 participants reported to have been hungover the previous day ('yesterday'), and N = 87 participants reported to have been hungover two days before the assessment ('2 days ago'). The analyses revealed that baseline mood and mood while drinking had no relevant effect on the amount of consumed alcohol and did not significantly contribute to hangover severity. However, hangover severity was associated with significantly increased negative affect, particularly with higher levels of subjective stress on the day of the hangover.

The Association between Alcohol Hangover Frequency and Severity: Evidence for Reverse Tolerance?

Although hangover is a common consequence of heavy alcohol consumption, the area is heavily under-researched. Hangover frequency is a potential predictor of future alcohol use disorder that may be affected by hangover severity, yet the relationship between hangover frequency and severity has not been investigated. Using different methodologies and assessment instruments, two surveys, and one naturalistic study collected data on hangover frequency, hangover severity, and alcohol consumption. The relationship between hangover frequency and severity was investigated via correlational analysis, considering potentially moderating variables including alcohol intake, estimated blood alcohol concentration, demographics, and personality characteristics. In all the three studies, a positive and significant association between hangover frequency and severity was found, which remained significant after correcting for alcohol intake and other moderating factors. These findings suggest that hangover severity increases when hangovers are experienced more frequently and may be driven by sensitization or reverse tolerance to this aspect of alcohol consumption. Future research should further investigate the relationship between hangover frequency and severity and alcohol use disorder and its implications for prevention.

Alcohol Hangover Increases Conflict Load via Faster Processing of Subliminal Information

The detrimental effects of acute alcohol intoxication and long-term alcohol (ab)use on cognition are well-known. Yet, only little is known about the cognitive effects of an acute alcohol hangover, even though it might affect executive functions associated with workplace performance or driving skills. Given that alcohol hangover may increase the speed of information accumulation, we assessed the behavioral effects of conflict load (induced by a subliminal prime) on cognitive control, as assessed via the Flanker effect. We employed a counter-balanced within-subject design, where n = 25 healthy young males were tested once after a sober night and once after a night of experimentally induced heavy drinking of cheap brandy/red wine (2.6375 g alcohol per estimated liter of body water within 2–3 h). Alcohol hangover neither increased the cognitive conflicts induced by consciously processed distractors alone (i.e., the Flanker effect), nor modulated conflict adaptation (i.e., the Gratton effect). Instead, hangover potentiated the detrimental effects of conflicting subliminal primes on top-down cognitive conflicts. This effect was likely due to an increase in the speed of information accumulation from visual stimuli and the resulting increase in subliminal conflict load induced by incompatible primes. We further found the size of this effect to be positively correlated with age and subjective sleepiness during the hangover state, but the hangover effect remained significant even after correcting for those covariates. We further found no correlation of the behavioral effect with the subjective overall rating of hangover symptoms or the maximal breath alcohol concentration reached during prior intoxication. Taken together, our findings suggest that alcohol hangover may affect cognitive performance due to an increase in non-conscious processing of visual distractors. While the size of this effect might increase with age and sleepiness, it is not entirely dependent on those covariates and not necessarily related to subjective ratings of general hangover symptoms/impairment.

Hangover in Post-College-Aged Drinkers: Psychometric Properties of the Hangover Symptom Scale (HSS) and the Hangover Symptom Scale-Short Form (HSS-5)

BACKGROUND

Alcohol hangovers have been found to be a common and costly consequence of alcohol misuse. However, there is only limited psychometric support for instruments to accurately measure hangovers beyond the college-age years. This study investigated the psychometric properties of the Hangover Symptom Scale (HSS) and the Hangover Symptom Scale-Short Form (HSS-5) including the internal consistency, convergent and discriminant validity, construct validity, and the measurement invariance of these scales between light and heavy drinkers, individuals with a positive and negative family history of alcohol use disorder (AUD), and men and women in a post-college-aged sample. The association of the HSS and HSS-5 with alcohol use problems was also tested.

METHODS

Participants were 294 nonalcoholic light and heavy social drinkers (age range 21 to 35 years; 57.8% male) enrolled in the Chicago Social Drinking Project. They completed the HSS as part of a take-home packet completed outside of the laboratory. The psychometric properties of the HSS and HSS-5 were tested.

RESULTS

Stronger psychometric support was found for the HSS-5 relative to the full HSS. While both measures demonstrated strong internal consistency reliability, convergent and discriminant validity, and an association with alcohol use problems, only the HSS-5 showed construct validity as determined by confirmatory factor analysis. Further, only the HSS-5 showed measurement invariance between men and women, light and heavy drinkers, and individuals with a positive and negative family history of AUD.

CONCLUSIONS

This was the first study to examine the psychometric properties of the HSS and HSS-5 in a post-college-aged sample and the first to investigate the measurement invariance of these measures as a function of sex, drinking history, and family history of AUD. This study supports the use of the HSS-5 as a reliable and valid brief measure of frequency of hangover symptoms.