Chances are if you are one of the 136.9 million current American drinkers of alcohol, one-quarter of whom binge drank in the last month, as reported by the National Survey on Drug Use and Health (NSDUH) of 2013, you have likely experienced a hangover at some point.
Alcohol, particularly binge drinking, cost the United States approximately $224 billion in 2006 in lost workplace production, law enforcement, health care expenses related to alcohol, motor vehicle accidents, and fatality expenses, according to the Centers for Disease Control and Prevention (CDC). Much research has been done on exactly what causes a hangover’s misery, as well as how to treat or cure it. Researchers and scientists are constantly proving and then disproving theories as to how and why alcohol, which is generally speaking distilled ethanol, reacts on the brain the way it does. Scientists even have a medical term for hangovers – veisalgia.
Most researchers agree that hangovers, as well as intoxication, are caused by an imbalance of chemicals in the brain. At this point, they still disagree on which imbalance directly relates to hangover symptoms, however. Some believe that hangovers are due to the buildup of acetaldehyde, which is a byproduct created as the body processes ethanol and is 10 to 30 times more toxic than alcohol itself, as published by the Smithsonian. Others discuss the potential link between the conversion of the enzyme NAD+ to NADH that needs to happen during alcohol processing, which may interfere with the cell’s other metabolic duties and increase hangover symptoms. Both of these theories have their critics, however.
The most current research seems to support a connection between hangovers and an immune system response or, more specifically, the production of cytokines. These molecules are some of the central nervous system’s natural messengers and usually produced in an attempt to ward off an infection and as an inflammatory immune system response. Cytokines produce many of the same symptoms as a hangover itself, including cognitive as well as physical impairments. Research seems to indicate an increased level of cytokines in those suffering from a hangover, as reported in the journal Alcohol.
If you raise your blood alcohol content (BAC) to 0.10 g/dl or above, you are likely to experience symptoms of a hangover the next day. These symptoms generally peak between 12 and 24 hours after your BAC has returned to zero and may include:
These symptoms may be experienced in varying levels and severity. Just as BAC levels depend on alcohol tolerance, genetic makeup, and type of alcohol consumed, so do hangover side effects. The amount of food you have in your system can also lessen the severity or potential for a hangover. It doesn’t seem to matter so much what type of food you eat, just that you have something in your digestive tract slowing down the processing of alcohol through your stomach and intestines and into your bloodstream.
Generally, symptoms will improve on their own and don’t need to be managed medically; however, if you notice signs of confusion, vomiting, seizures, blue-tinged skin, irregular breathing or body temperature, trouble remaining awake, or loss of consciousness, it may actually be alcohol poisoning, which is a form of alcohol overdose that can be life-threatening and requires immediate medical attention.
Some factors do not directly cause hangovers but may contribute to their severity including:
Congeners are the chemicals produced during alcohol fermentation. Alcohol that is darker in color typically has more congeners than lighter colored alcoholic beverages. A Dutch study published in the Oxford Journals indicates that alcohol with higher concentrations of congeners therefore accounts for more severe hangovers, and consuming fewer drinks but with more congeners will have similar effects as drinking more beverages with fewer congeners. Brandy, red wine, rum, and whiskey top the list of higher congener content and more severe hangover symptoms, with white wine, gin, vodka, beer, and ethanol dissolved in orange juice in descending order having fewer congeners and hangover symptoms when consumed. A study published in Scientific American reported that bourbon whisky has 37 more times the congeners that vodka does, for example, which is largely due to the way it is aged.
Since alcohol seems to affect the immune system, symptoms of a hangover may be worse in those with weakened or less functional immune pathways. Drinking time may also cut into sleeping time, and someone who is less rested may experience a more sever hangover than someone who isn’t. Many of the hangover symptoms may also be symptoms of a lack of quality sleep as well, further indicating a correlation between sleep and hangover severity.
A genetic mutation that many people of Eastern Asian decent seem to have prevents the metabolic step of converting acetaldehyde into acetic acid, causing a rapid buildup of acetaldehyde and the alcohol flush syndrome. This mutation may decrease the odds of developing an alcohol dependency; however, it may also increase the severity of hangovers the next day.
Mixing alcohol with other drugs, including nicotine, can also increase the severity of a hangover and have further complications or health risks. Women process alcohol differently than men, which may be due partly to hormonal differences but is largely related to the differences in body water. Women, according to Brown University, have an average body water rate of 52 percent while men are closer to 61 percent on average. This allows men to process or dilute alcohol more quickly than women of the same body weight.
Alcohol is a known central nervous system depressant, affecting the natural reward circuitry and the production of neurotransmitters such as dopamine and gamma aminobutyric acid (GABA). Dopamine is an excitatory neurotransmitter responsible for pleasure while GABA is an inhibitory neurotransmitter that causes relaxation and a sense of calm.
Richard Olsen is a neuroscientist at UCLA who is studying alcohol use and the response of neural mechanism to it in relation to both intoxication levels and hangovers, as reported by Wired. His research seems to indicate that certain GABA receptors are highly sensitive to the presence of ethanol and blocking these receptors may lessen hangover symptoms. Research is still ongoing; however, Olsen and one of his postdoctoral students Jing Liang found that certain Chinese herbs and traditional medications had an ingredient, ampelopsin, that they were able to isolate. They created a pill marketed over the counter as BluCetin that seems to decrease intoxication and hangover symptoms. While this is not approved for use on hangovers by the FDA, scientists are working to discover a cure for a hangover.
People have been searching for a cure for hangovers for years, and many swear by methods such as “hair of the dog” or drinking more to cure the symptoms, although this likely just leads to more intoxication and another future hangover. Prickly pear cactus extract is thought to be effective, although hard to find, and many other substances are marketed as the cures for hangovers, although most are without scientific merit. The best way to avoid hangover symptoms is to drink in moderation if you choose to drink alcohol at all.
When hangovers begin to affect your quality of life and become more than just a once in a while occurrence, you may be suffering from an alcohol use disorder. Additionally, if alcohol affects your interpersonal, social, and physical well-being yet you choose to drink anyway, alcohol treatment can greatly improve your quality of life. Treatment targets both the physical and emotional components of addiction. FRN treatment centers offer the highest quality of comprehensive care. Call us to learn more about our programs.
Integrated Treatment of Substance Abuse & Mental Illness