such as job performance and driving.In addition, researchers know litt - PDF document

such as job performance and driving.In addition, researchers know littleabout hangover prevention and treat-ment. Although folk remedies forhangovers abound, their efficacy inreducing the intensity and duration of a hangover has not received system-atic study. In fact, some researchersan effective treatment for hangovers is desirable, given that the hangoverfrom engaging in subsequent episodesAlthough gaps clearly remain inscientific knowledge about hangovers,research has elucidated several aspects.This article describes what is knownabout the hangover condition, theingto it, and treatment options. What Is a Hangover? A hangover is characterized by thetable 1). Physical symptoms of ahangover include fatigue, headache,increased sensitivity to light andsound, redness of the eyes, muscleaches, and thirst. Signs of increasedsympathetic nervous system activitycan accompany a hangover, includingincreased systolic blood pressure,rapid heartbeat (i.e., tachycardia),tremor, and sweating. Mental symp-room spinning (i.e., vertigo); andpossible cognitive and mood distur-bances, especially depression, anxiety,and irritability. The particular set ofsity may vary from person to personand from occasion to occasion. Inaddition, hangover characteristics maydepend on the type of alcoholic beveragedrinks. Typically, a hangover beginswithin several hours after the cessationalcohol concentration (BAC) is falling.Symptoms usually peak about thetime BAC is zero and may continuefor up to 24 hours thereafter. Overlap exists between hangover anddrawal (AW), leading to the assertionthat hangover is a manifestation ofmild withdrawal. Hangovers, how-ever, may occur after a single bout ofdrinking, whereas withdrawal occursusually after multiple, repeated bouts.Other differences between hangoverand AW include a shorter period ofimpairment (i.e., hours for hangoverversus several days for withdrawal)and a lack of hallucinations and seizuresin hangover. People experiencing a hangover feelill and impaired. Although a hangovermay impair task performance andthereby increase the risk of injury,equivocal data exist on whether hang-over actually impairs complex mentaltasks. When subjects with a BAC ofzero were tested following alcoholintoxication with peak BACnot show significant impairments inthe performance of simple mentaltasks, such as reaction time (Lemon etal. 1993). Similarly, several studiesthat investigated the hangover effectson a more complex mental task (i.e.,report impaired performance (Streufertet al. 1995; Tornros and Laurell 1991).In contrast, a study of military pilotsrevealed significant decrements insome performance measures (particu-holto be considered legally drunk(Yesavage and Leirer 1986). Prevalence of Hangover Generally, the greater the amount the more prevalent is the hangover,although some people report experi-encing a hangover after drinking lowlevels of alcohol (i.e., one to threedrinkers do not report experiencinghangovers at all. A survey by Harburgand colleagues (1993) on the preva-lence of hangovers found that approx-imately 75 percent of the subjectswho drank to intoxication reportedexperiencing a hangover at least someof the time. In a study of 2,160 Finnishmen, researchers found an associationbetween increased weekly alcoholconsumption and the frequency ofhangover: 43.8 percent of the groupwho drank more than 106 grams [g]of alcohol per week or approximately9 drinks) reported experiencing a hang-overmonthly or more often, comparedwith 6.6 percent of the remstudy subjects (Kauhanen etal. 1997).Similarly, in a study of 1,041 drinkersin New York State, 50 percent of thesubjects who drank two or more drinksper day reported experiencing hang-overs in the previous year, whereassubjects who consumed lower levels Vol. 22, No. 1, 199855 Table 1 Symptoms of Hangover Class of SymptomsType Constitutional Fatigue, weakness, and thirstPainHeadache and muscle achesGastrointestinalNausea, vomiting, and stomach painSleep and biological rhythmsDecreased sleep, decreased REM,SensoryVertigo and sensitivity to light and sound CognitiveDecreased attention and MoodDepression, anxiety, and irritabilitySympathetic hyperactivityTremor, sweating, and increased pulse Alcohol Hangover of alcohol reported fewer hangovers(Smith and Barnes 1983). Other reports,however, claim that hangovers occurless often in heavy drinkers. In a studyinpatient treatment, 50 percent of thesubjects reported experiencing no hang-overswithin the previous year and 23percent reported never experiencing ahangover (Pristach et al. 1983). Physiological Factors Contributing to Hangover Hangover symptoms have beenattributed to several causes (see table2), including the direct physiologicalother organs; the effects of the removalof alcohol from these organs aholexposure (i.e., withdrawal);theproduced as a result of alcoholcially acetaldehyde; and nonalcoholfactors, such as the toxic effects ofother biologically active chemicals (i.e.,congeners) in the beverage, behaviorsbout (e.g., other drug use, restrictedfood intake, and disruption of normalsleep time), and certain personal char-acteristics(e.g., temperament, person-ality, and family history of alcoholism).Although current evidencesuggests thatmore than one factor mosttributes to the overall hangover the following sections address each of Direct Alcohol Effects Alcohol may directly contribute to ahangover in several ways, includingthe following. Dehydration and Electrolyte Imbal- Alcohol causes the body to increaseurinary output (i.e., it is a diuretic).250 milliliters (mL) of water(i.e. approx-of 600 to 1,000mL (or up to 1 quart)of water over several hours (Montastruc1986). Alcohol promotes urine pro-duction by inhibiting the release of ahormone (i.e., antidiuretic hormone,or vasopressin) from the pituitary gland.In turn, reduced levels of antidiuretichormone prevent the kidneys fromreabsorbing (i.e., conserving) waterand thereby increase urine production.Additional mechanisms work to increase urine production,however, because antidiuretic hormonelevels increase as BAC levels decline tozero during hangover(Eisenhofer et al.1985). Sweating, vomiting, and diarrheaover, and these conditions can result inadditional fluid loss and electrolyteimbalances. Symptoms of mild to mod-dehydration include thirst, weak-ness, drcommonly observed during a hangover. Gastrointestinal Disturbances. directly irritates the stomach anddelayed stomach emptying, especiallywhen beverages with a high alcoholconcentration (i.e., greater than 15percent) are consumed (Lieber 1995).High levels of alcohol consumptionalso can produce fatty liver, an accu-triglycerides and their components(i.e., free fatty acids) in liver cells. Inaddition, alcohol increases the produc-tionof gastric acid as well as pancreaticand intestinal secretions. Any or all ofthese factors can result in the upperabdominal pain, nausea, and vomitingexperienced during a hangover. Low Blood Sugar. Several alterationsin the metabolic state of the liver andother organs occur in response to thepresence of alcohol in the body andcan result in low blood sugar levels(i.e., low glucose levels, or hypoglycemia)(National Institute on Alcohol Abuseolism leads to fatty liver (describedmetabolic product, lactic acid, in bodyfluids (i.e., lactic acidosis). Both oftheseeffects can inhibit glucose production. Alcohol-induced hypoglycemiaover several days in alcoholics who havenot been eating. In such a situation,prolonged alcohol consumption, cou-pledwith poor nutritional intake, notonly decreases glucose production butalso exhausts the reserves of glucosestored in the liver in the form of glyco-gen,thereby leading to hypoglycemia.Because glucose is the primary energysource of the brain, hypoglycemia cancontribute to hangover symptomssuch as fatigue, weakness, and mooddisturbances. Diabetics are particularlysensitive to the alcohol-induced alter-ations in blood glucose. However, itlow blood sugar concentrations con-tribute to hangover symptomatically. 56 Table 2 Possible Contributing Factors to HangoverDirect effects of alcoholAlcohol withdrawal Disruption of Sleep and Other Biological Rhythms. has sedative effects that can promoteduring a hangover results from alcoholdisruptive effects on sleep. Alcohol-induced sleep may be of shorter durationand poorer quality because of reboundexcitation (see the section Effects ofAlcohol Withdrawal) after BACsfall,leading to insomnia (Walsh et al. 1991).Furthermore, when drinking behaviortakes place in the evening or at nightsleep time, thereby reducing the lengthdisrupts the normal sleep pattern,decreasing the time spent in the dream-ingstate (i.e., rapid eye movement[sleep) and increasing the time spentin deep (i.e., slow-wave) sleep. Inaddition, alcohol relaxes the throatmuscles, resulting in increased snoringand, possibly, periodic cessationofbreathing (i.e., sleep apnea). Alcohol interferes with other biolog-rhythms as well, and these effectspersist into the hangover period. Forexample, alcohol disrupts the normal24-hour (i.e., circadian) rhythm in bodytemperature, inducing a body temper-ature that is abnormally low duringintoxication and abnormally high duringa hangover. Alcohol intoxication alsointerferes with the circadian nighttimesecretion of growth hormone, whichis important in bone growth andprotein synthesis. In contrast, alcoholinduces the release of adrenocortico-tropic hormone from the pituitaryrelease of cortisol, a hormone that playsa role in carbohydrate metabolism andstress response; alcohol thereby disruptsthe normal circadian rise and fall ofcortisol levels. Overall, alcohols disrup-tionof cir that is hypothesized to accounthangover (Gauvin et al. 1997). Alcohol and Headache In a large epidemiological survey ofheadache in Danish 25- to 64-year-olds,the lifetime prevalence of hangoverheadache was 72 percent, making itreported (Rasmussen and Olesen 1992).Alcohol intoxication results in vasodi-Alcohol has effects on several neuro-transmittersand hormones that areaches, including histamine, serotonin,and prostaglandins (Parantainen 1983).However, the etiology of hangoverheadache remains unknown. Effects of Alcohol Withdrawal The AW syndrome following thecessation of excessive drinking resultsfrom compensatory changes in thecentral nervous system that take placein response to chronically administereddepressant substances (in this case,alcohol, or more specifically, ethanol).two types of receptors embedded innerve cell membranes. One receptortype binds with an important chemi-cal messenger (i.e., neurotransmitter)with another neurotransmitter, gluta-mate. Both GABA and glutamate arecritical in regulating nerve cell activity:s primary means of inhibiting nerve cell activity, andglutamate is the primary means ofexciting it. Following chronic alcohol exposure,the body decreases (i.e., downregulates)receptors and increases (i.e., upregulates)receptors in an effort to counterbalances sedative effects. When alcoholis removed from the body, however, thecentral nervous system and the portionof the nervous system that coordinatesresponse to stress (i.e., the sympatheticnervous system) remain in an unbal-overdrive state (Tsai et al. 1995).Sympathetic nervous system hyperac-tivity accounts for the tremors, sweating,and tachycardia observed in both hang-overand AW syndrome.Several lines of evidence suggest thata hangover is a mild manifestation ofthe AW syndrome in non-alcohol-dependent drinkers. First, the signsand symptoms of hangover and mildAW overlap considerably. The revisedClinical Institute Withdrawal Assess-for Alcohol (CIWA-Ar) scale, aninstrument widely used to assess theseverity of a withdrawal episode inalcohol-dependent patients, measuresand vomiting; tremor; sweating; anxi-tation(e.g., awareness of the date andlocation) (Sullivan et al. 1989, see alsop. 8 of the article by Saitz for a sampleof the assessment form). Several ofthese items also are usually presentduring a hangover, including nauseaand vomiting, tremor, sweating, anxiety,headache, and sensory disturbances. Second, Begleiter and colleagues(1974) present evidence that thehangover condition is actually a stateof central nervous system excitation,despite the perceived sedation andmalaise. Support for this view comesfrom the research of Pinel and Mucha(1980), which shows that single dosesof alcohol decrease seizure thresholdsin animals several hours later. Theirfinding indicates rebound excitation,short-term administration of somesedatives that can quickly clear thebody, including alcohol and certainbenzodiazepine drugs. Third, the observation that alcoholreadministration alleviates the unpleas-antnessof both AW syndrome andhangovers suggests that the two expe-riences share a common process. Effects of Alcohol Metabolites Alcohol undergoes a two-step processin its metabolism (see figure). First, anenzyme (i.e., alcohol dehydrogenase)metabolizes alcohol to an intermediateproduct, acetaldehyde; then a secondenzyme (aldehyde dehydrogenase[ALDH]) metabolizes acetaldehyde toacetate. Acetaldehyde is a chemicallyreactive substance that binds to pro-teins and other biologically importantcompounds. At higher concentrations,it causes toxic effects, such as a rapidpulse, sweating, skin flushing, nausea,and vomiting. In most people, ALDH Vol. 22, No. 1, 199857 Alcohol Hangover metabolizes acetaldehyde quickly andefficiently, so that this intermediateare present in the blood during alcoholintoxication. In some people, however,genetic variants of the ALDH enzymepermit acetaldehyde to accumulate.Those people routinely flush, sweat,Because of the similarity betweenthe acetaldehyde reaction and a hang-over, some investigators have suggestedthat acetaldehyde causes hangovers.Although free acetaldehyde is not pre-sentin the blood after BACs reachzero, the toxic effects of acetaldehydeproduced during alcohol metabolismmay persist into the hangover period. Effects of Factors Other Than Alcohol Factors other than alcohol also maycontribute to a hangover. These factorsinclude the following possibilities. Congeners. Among other reasons,people consume alcoholic beveragesfor their ethanol content. Most alcoholicbeverages contain smaller amounts ofother biologically active compounds,however, including other alcohols.These compounds, known as congeners,appearance of alcoholic beverages.Congeners may be produced alonggenerated during aging or processingthrough the degradation of the bever-to the beverage during the productionprocess. Investigators now believe beverages intoxicating effects and to a subsequent hangover. Research has shown that beverages composedof more pure ethanol, such as gin or vodka, induce fewer hangovereffects than do beverages containing as whiskey, brandy, or red wine(Chapman 1970; Pawan 1973). Ahangover also may occur when pureethanol is administered, however.One specific congener implicatedin hangover effects is methanol, whichalcoholic beverages along with ethanol.chemical structure in that methanolfewer hydrogen atoms than ethanol.The same enzymes that metabolizeethanol, alcohol dehydrogenase, andaldehyde dehydrogenase also metabo-lize methanol; however, the productshydeand formic acid) are extremelytoxic and in high concentrations maySupport for methanolto hangovers comes from several sources.For example, distilled spirits that aremore frequently associated with thedevelopment of a hangover, such asMoreover, in an experimental studywith four subjects who consumed redliter (mg/L) of methanol, Jones (1987)found that elevated blood levels ofmethanol persisted for several hoursafter ethanol was metabolized, whichcorresponded to the time course ofhangover symptoms. Methanol lingersafter ethanol levels drop, because ethanolcompetitively inhibits methanol metab-olism. The fact that ethanol readmin-istration fends off hangover effectsmay be further evidence of methanolcontribution to the hangover condition,given ethanolmetabolism and thereby slow the pro-ductionof formaldehyde and formic acid.Certain people develop headachessoon after drinking red wine but notafter drinking white wine or vodka.Recent research finds that red wine, butnot white wine or vodka, can increaseplasma serotonin and plasma histaminelevels. The specific agents in wineresponsible for these increased levelsare not known. Increased plasma sero-toninand histamine can trigger head-aches in susceptible people (Pattichiset al. 1995; Jarisch and Wantke 1996). Use of Other Drugs. drugs often accompanies heavy alcoholconsumption. Most heavy drinkerssmoke cigarettes, and some also usemarijuana, cocaine, or other drugs.Although certain drugs can themselvesproduce hangover symptoms and affectalcohol intoxication, the effects of thevarious alcohol and other drug combina-tions on alcohol hangover are unknown. Personal Influences. Some evidenceexists that increased hangover symptomsoccur more often in people possessingcertain personality traits, such as neu-roticism, anger, and defensiveness.Negative life events and feelings of guiltabout drinking also are associated withexperiencing more hangovers (Harburget al. 1993). In addition, Earleywine a,b ) reports greater hangoversymptoms in people who have a higherpersonality risk for the development ofalcoholism (as measured by the Mac- 58 OHADHCHCHOALDHCHEthanolAcetaldehydeAcetateNADNADHNADNADH NOTE: ADH = alcohol dehydrogenase; ALDH = aldehyde dehydrogenase; NAD = nicotinamide adeninedinucleotide; NADH = reduced NAD. Andrew Scale [MacAndrew 1965]).have an elevated personality risk foralcoholism experience more acutewithdrawal and hangover symptomsand may initiate further drinking in aneffort to find relief.Research has shown that a historya positive family history) is associatedwith a decreased sensitivity to the intox-effects of alcohol and a greaterrisk for developing alcoholism (Schuckitand Smith 1996). Newlin and Pretorius(1990) suggested that a positive familyhistory for alcoholism may be associatedwith a tendency for increased hangoversymptoms as well. Their researchcompared the self-reported hangoverthat the subjects with a positive fam-ily history for alcoholism had hadgreater hangover symptoms during theprevious year. The amount of drink-ing was comparable between the twogroups, although the subjects with apositive family history reported con-suming significantly more mixeddrinks than the group with a negativefamily history. Treatments for Hangover Many treatments are described to pre-venthangover, shorten its duration,and reduce the severity of its symptoms,including innumerable folk remediesand recommendations. Few treatmentshave undergone rigorous investigation,however. Conservative managementoffers the best course of treatment.Time is the most important compo-nent, because hangover symptomswill usually abate over 8 to 24 hours.Attentiveness to the quantity andquality of alcohol consumed can havea significant effect on preventing hang-over.Hangover symptoms are lesssmall, nonintoxicating amounts. Evenamong people who drink to intoxication,those who consume lower amounts ofalcohol appear less likely to develop ahangover than those who drink higheramounts. Hangovers have not beenassociated with drinking beverages witha low alcohol content or with drinkingnonalcoholic beverages.may have a significant effect on reduc-inghangover (Chapman 1970; Pawan1973). Alcoholic beverages that containfew congeners (e.g., pure ethanol, vodka,and gin) are associated with a lowerincidence of hangover than are beverages(e.g., brandy, whiskey, and red wine). Other interventions may reduce theintensity of a hangover but have nottion of fruits, fruit juices, or otherfructose-containing foods is reportedto decrease hangover intensity, forexample (Seppala et al. 1976). Also,bohydrates, such as toast or crackers,can counter low blood sugar levels inpeople subject to hypoglycemia andcan possibly relieve nausea. In addition,associated with sleep deprivation, anddrinking nonalcoholic beverages duringreduce alcohol-induced dehydration.Certain medications may providesymptomatic relief for hangover symp-toms.For example, antacids may alleviatenonsteroidal anti-inflammatory medi-cations (e.g., ibuprofen or naproxen)may reduce the headache and muscleaches associated with a hangover butshould be used cautiously, particularlypresent. Anti-inflammatory medicationsare themselves gastric irritants andcommon alternative to aspirin, its useshould be avoided during the hangovers toxicity tothe liver (Girre et al. 1993).Propranolol, a beta-adrenergicused to treat high bloodpressure and migraine headaches, re-of AW; however, a small, double-blind,placebo-controlled study did not findpropranolol to be effective in reducinghangover symptoms, including headacheserotonin-3 receptor,setron and tropisetron, are antiemetics(i.e., they control nausea and vomiting)and block certain alcohol effects; how-ever,a small clinical trial did not showefficacy in alleviating hangover (Muh-actthe fatigue and malaise associatedwith the hangover condition. Althoughsupport, William Hickey, quoted at thebeginning of this article, wrote thatvery strong coffee proved of infinite (Spenser 1913).Readministration of alcoholhair of the dog that bit you remedyreportedly cures a hangover, but peopleexperiencing a hangover should avoidfurther alcohol use. Additional toxicity of the alcohol consumed duringthe previous bout and may increase thelikelihood of even further drinking. Areas for Future Study Several topics related to hangoverswarrant research attention. The effectthe occurrence of hangover needs closerexamination, for example. Such researchethanol or congeners that produce themajor signs and symptoms of hangover,and an answer to this key questionwould advance our understanding ofhangover pathophysiology. A particularly intriguing observationan increased risk for alcoholism (e.g.,certain personality factors or a positivefamily history for alcoholism) experiencemore severe hangovers. Although logicdictates that enduring more severe or Vol. 22, No. 1, 199859 Alcohol Hangover 1blocks the action of another agent, disease, orserotonin, a neurotransmitter that can affect more frequent hangovers would deter,rather than promote, further alcoholdrinking, mild AW symptoms are alsoassociated with an increased for alcohol (Littleton and Little1994).Future investigations could focusonpredisposed to experience more severeAW and whether such a tendency inturn predisposes them to increasedAnimal models of hangover havebeen developed and may provide in-immediately after intoxication (Gauvincould be used to explore the effects ofearly withdrawal and of congeners andtodetermine whether hangovers predisposeto or deter further alcohol consumption.In summary, hangover is a complexstate that probably cannot be under-stood by a unitary explanation. Ustanding the hangover condition,how-ever, will lead to a better comprehensionand the adaptive responses that alco-  References B Psychopharmacologia 37(1):15M.J. Propranonol for the treatment of alcoholichangover. American Journal of Drug & AlcoholAbuse 13(1&2):175Ð180, 1987.C, L.F. Experimental induction of hang-over. Quarterly Journal of Studies on Alcohol 5(Suppl. 5):67Ð86, 1970.E, M. Hangover moderates the associ-ation between personality and drinking problems. AddictiveBehaviors 18(3):291Ð297, 1993 a .E, M. Personality risk for alcoholismcovaries with hangover symptoms. Addictive 18(4):415Ð420, 1993 b .E, D.G.; WHITESIDE, R.H. Vasopressin concentrationsduring alcohol withdrawal. British Journal ofAddiction 80(2):195Ð199, 1985.GHENG Recent Developments in Alcoholism: Volume 11.Ten Years of Progress, New York: Plenum Press,Ð304.G, F.A. Cross-generalization of an EtOH endogenously and exogenously induced stimuli. Pharmacology Biochemistry and Behavior , S.Increased metabolism of aceta- Alcoholism: Clinical & Experimental Research 17(1):Ð173, 1993.HFalcohol use, and hangover signs among social Journal ofClinicalEpidemiology , F.Wine and headache. International Archives of Allergy and Immunology 110(1):7Ð12, 1996.J, A.W. Elimination half-life of methanolduring hangover. Pharmacology & Toxicology 60(3):217Ð220, 1987.KOLDBERG, D.D.;, R.D.; L Epidemiology 8(3):310, G.; FREELEY, C. Investigation of the hangovereffects of an acute dose of alcohol on psychomo- Alcoholism: Clinical and Exper-imental Research 17(3):665Ð668, 1993.L, C.S. Medical disorders of alcoholism. NewEngland Journal of Medicine ofethanol dependence. Addiction 89(11):1397Ð1412, 1994.M, C. The differentiation of malealcoholic outpatients from nonalcoholic psychiatric Quarterly 26(2):238 HCEIA Informations , M.Tropisetron Addiction Biology 2(4):461 Alcohol AlertNo. 26:Alcohol and Hormones. PH352. Bethesda, MD: the Institute, 1994.N, M.B. Sons ofalcoholics report greater hangover symptoms than sons Alcoholism: Clinical 14(5):713Ð716, 1990.P, J. Prostaglandins in alcohol intol-erance and hangover. Drug and Alcohol Dependence , V.5-hydroxytryptamine European Journal of , G.L.Alcoholic drinks and hangover effects. Proceedings of the Nutrition Society 32(1):15A, 1973.tibility to seizures following brief exposure to Animal Models in Alcohol Research . New York:Academic Press, 1980. pp. 413 Drug and Alcohol Dependence , J.Symptomatic Neurology 42(6):1225Ð1231, 1992.S, T.L. An 8-yearfollow-up of 450 sons of alcoholic and control Archives of General Psychiatry , R.H.Effects of hangover Acta Pharm-acologia Toxicologia 38:209Ð218, 1976. S Drug 11(3/4):249Ð269, 1983.S Memoirs of William Hickey. Lon-don: Hurst & Blackett Ltd., 1913. pp. 103J.; , W. Alcohol hangover and man-agerial effectiveness. Alcoholism: Clinical andExperimental Research , E.M.Assessment British Journal of Addiction 84(11):Ð1357, 1989.T, H. Acute and hang-over effects of alcohol on simulated driving per- Blutalkahol 28(1):24Ð30, 1991.T American Journal of Psychiatry , P.K.Sedative Journal of Studies on 52(6):597Ð600, 1991.Yeffects on aircraft pilots 14 hours after alcohol American Journalof Psychiatry 143(12):1546Ð1550, 1986. 60 54 Alcohol Hangover Mechanisms and Mediators Robert Swift, M.D., Ph.D.; and Dena Davidson, Ph.D. Hangovers are a frequent, though unpleasant, experience among people who drink tointoxication. Despite the prevalence of hangovers, however, this condition is not wellunderstood scientifically. Multiple possible contributors to the hangover state have beeninvestigated, and researchers have produced evidence that alcohol can directly promotehangover symptoms through its effects on urine production, the gastrointestinal tract, bloodsugar concentrations, sleep patterns, and biological rhythms. In addition, researcherspostulate that effects related to alcoholÕs absence after a drinking bout (i.e., withdrawal),alcohol metabolism, and other factors (e.g., biologically active, nonalcohol compounds inbeverages; the use of other drugs; certain personality traits; and a family history ofalcoholism) also may contribute to the hangover condition. Few of the treatments commonlydescribed for hangover have undergone scientific evaluation. K My first return of sense or recol-strange, dismal-looking room, myhead aching horridly, pains of aviolent nature in every limb, andFrom the latter I was in somedegree relieved by a very copiousvomiting. Getting out of bed, Ilooked out of the only window inthe room, but saw nothing butthe backs of old houses, fromwhich various miserable emblemsof poverty were displayed . . . . Atthat moment I do not believe inthe world there existed a morewretched creature than myself. state little short of despair . . . . he British writer William Hickeywrote these words in the yearreferred to as a hangover. Similardescriptions of hangovers appear in thewritings of ancient Egypt and Greeceas well as in the Old Testament. Nodoubt, prehistoric people also experi-enced hangovers soon after theydiscovered alcohol. Despite its long history, however,hangover has received relatively scantformal attention from researchers.Little is known about the physiologyunderlying the hangover condition. Forexample, it is unclear whether hangoversigns and symptoms are attributables direct effects on the body,its aftereffects, or a combination of OBERTprofessor in the Department of Psychiatryand Human Behavior at Brown Univer-sity, Providence, Rhode Island, andassociate chief of staff for research andeducation at Providence VeteransAffairs Medical Center.AVIDSONprofessor of psychiatry at IndianaUniversity of Medicine, Indianapolis,Indiana.