If you have one too many tonight, among the things you might be wondering tomorrow morning—along with “Where is the Advil?” and “Can everyone please just shhh?”—are a number of existential queries that hangovers, in all their guilt-inducing agony, tend to stir. Like, “Is that ‘hair of the dog’ thing true?” or “Why is it that hangovers always make me swear off drinking forever, yet I don’t?”
This weekend in Seattle, an unusual group of scientists will gather to mull these and other questions at the meeting of the Alcohol Hangover Research Group. Their logo, fittingly, is a pint of beer next to a spilled glass of red wine.
Hangover research is a bit of a neglected field, not the highest priority in terms of health-research funding. But there’s a lot hangovers can tell us about our brains, our guts, and the epidemiology of alcoholism. Tell me how you feel the morning after getting blitzed, in other words, and I’ll tell you what you are.
Ahead of the meeting, I’ve interviewed Richard Stephens, a member of the group and a professor of psychology at Keele University in the UK, about some of the most surprising things scientists have learned recently about the “gallon distemper.” Stephens has published several papers about hangovers, including whether their severity declines with age. (Answer: Yes. Hang in there, 21-year-olds.)
I also asked him for some scientific hangover-cure recommendations, for a friend.
What are you presenting at the conference?
We’ve got a quite good research grant from the EU for a two-year project on alcohol hangover, particularly looking at the cognitive effects of hangover. In other words, if you have a hangover, does your memory function normally? And also looking at the link between alcohol hangover and alcohol use disorder. I’m going to be presenting some of the preliminary data from the study on that latter question about hangover and alcohol use disorder. The interest there is that everyone tends to think that hangover is a good thing because it stops you from drinking too much, it’s like the natural brake on drinking. And we all drink too much and that’s a big problem so anything that stops people from drinking too much is a good thing. That’s the kind of folk knowledge.
And yet, a number of studies have actually shown the opposite. If hangover is a natural brake on drinking, then alcoholics should get the least hangovers of anyone—that the reason they are alcoholic is that they don’t have that natural brake on drinking. But actually a number of studies in the US have actually shown the opposite, that alcoholics get the most severe hangovers, even when you control for the amount of alcohol consumed. And so it seems like it’s a more complex relationship between being at risk of alcoholism and hangovers.
Do you have any insights so far in how it affects cognitive functioning?
Yes, we do. The preliminary data are much clearer on the cognitive functioning side. We used a range of cognitive tests, and several of them showed deficits. Which is kind of in-keeping with the wider literature, there’s been probably 20 or 30 studies now looking at the links between hangover and cognitive function.
One of the things that makes our study interesting is just a methodological detail. There are two ways of doing hangover research—one is to do very carefully controlled studies in a lab where you give people measured amounts of alcohol and look at the effects. But the problem with that approach is, apart from the fact that it’s very expensive and resource intensive, that you can only give people fairly mild amounts of alcohol, ethically.
The other way of doing it is a naturalistic study—you get people into the lab the morning after a night when they’ve been out drinking anyway, and look for the natural symptoms of hangover following that episode. The good thing about the naturalistic approach is it’s real drinking and it’s much more ecologically valid, it’s much more mimicking what happens in real life, and that you can get a greater range of alcohol consumption, with some people at the top end drinking much more significant amounts of alcohol than would be allowed in a carefully controlled lab study.
The problem with that approach though, is that people know they’re in a hangover study, because they know that’s why they’ve contacted you, so they probably feel a bit rough and know they don’t have to try very hard because it’s a hangover study anyway. So there are expectancy effects there. So what we’ve done in this study, which is completely novel, is we’ve recruited some people to come into the lab on a morning when they’re likely to have been drinking the night before, but there’s nothing in the information to suggest we’re doing a study on hangover. But where, incidentally, they have been drinking, which in most cases they have, because we timed it that way, we can look at the effects without that expectancy element. Obviously people know they’ve been drinking but they don’t know that we’re interested in that, so in that sense they’re going to be like anybody who turns up to work having been drinking. They’re going to do the best they can with the hangover.
Do we know what causes hangovers?
Not completely, but there’s definitely some fairly good evidence. One component is the way that alcohol is metabolized. When you drink alcohol, there’s an enzyme in the body that breaks down the ethanol in alcohol into metabolites—after you’ve had a drink of alcohol and felt drunk, once you start to feel sober again, that’s because your body has metabolized the ethanol. But once the ethanol has been metabolized, there are usually other alcohols in smaller quantities in alcoholic beverages. One such compound is methanol, and when the body metabolizes methanol, it metabolizes it into toxins—formaldehyde and formic acid. And those make you feel ill, sort of poison you a little bit.
So one part of a hangover is the production of formaldehyde and formic acid, which comes online about 10 or so hours after you’ve been drinking. And the interesting thing about that is that the enzymes in your body that break down alcohols would prefer to break down ethanol first and methanol second. And it means that when you’re in a hangover phase, if you drink more alcohol you’ll actually stop your body from breaking down methanol and the things that are making you feel ill, and instead go back to working on the ethanol and leave the methanol intact. So there is a biological basis for the hair of the dog. And that’s one of the possible risk factors for why hangover might be a risk factor for alcoholism rather than a natural block for it.
But that’s not the only mechanism, there are other mechanisms as well. Another mechanism for hangover is immunosuppression. So you know that puffy feeling you get after a night of drinking—that’s due to an immune response.
How long have you been studying hangovers?
Probably about 10 years.
How has the science of hangovers changed since you first began working on this subject?
There are more people working on it now. When I started working on it, there were only a handful of papers. There was a lot of stuff in the 70s, and then it all petered out, and then it resurged in the late 90s and early 2000s.
How it’s changed is that knowledge has advanced—when we started off, the cognitive effects were clear. We did a big review in 2008 of all the cognitive effects studies of hangover that existed and concluded from that that there was some evidence of long-term memory and attention deficits. But it was very muddy. Say there were six or seven studies that had looked at attention, five or so showed something and the other two didn’t. Science is never as clear cut as you think it’s going to be. But since then, there have been more studies done and there is now a clearer picture of attention and memory being affected. And one thing we’re trying to do in our study is to look in a bit more detail at what particular aspects of attention and memory are affected.
Another development is there’s a psychological function known as executive function—that’s our ability to think laterally and plan. It’s almost like the mind taking control of itself and saying “okay, where are we, what do we want to do next,” and deliberately planning actions known as executive functions. And that’s been very largely neglected in hangover research, even though there’s evidence that alcohol use affects executive function. So one thing we’re doing that is novel is to look in quite a lot of detail at hangover affects executive functioning.
Why are we still missing some knowledge about hangovers? Why do we still not know a lot about how they work?
Well, it’s still not a mainstream research topic, really. Most alcohol researchers are looking at the acute effects of alcohol or more direct questions around what leads to alcohol use disorder.
And the funding is still going towards more direct questions. One of the reasons we still don’t know much is because the research effort in this area is much less in this area than in other areas, and maybe rightly so. Maybe there are more pressing questions around alcohol that are being funded, but one thing about science is that you can never discount where the next big discovery is going to come from.
Do ever find that other scientists look down on you or judge you because you study something that’s related to a vice?
I think that’s probably one reason why hangover hasn’t been studied so much. I just think it’s been neglected for whatever reason. But some of us think it’s interesting, and we’re pursuing it.
What, to you, have been some of the most exciting breakthroughs in hangover science recently?
I think one of the best papers on hangover was one of Joris Verster’s papers on the causes of hangover. It really is a document of what we know about it. [Ed: Verster's paper systematically reviewed common hangover "cures" and found only a few to be supported by one or two studies. Still, Verster concluded that "the best way to avoid hangovers is practicing abstinence or moderate alcohol consumption."]
I suppose that one breakthrough is when we founded the Alcohol Hangover Research group—that made us much more organized. We had our first hangover research meeting in 2010 in San Antonio, Texas. That was a really good moment, because personally for me I met all these people who I’d only ever read. I suppose that was more of a personal thing than a breakthrough.
Do you think we will ever find a cure for hangovers?
There is research looking at hangover cures. A few things were tried and found to heal hangover symptoms—one of them was anti-inflammatory drugs that you might take when you have a headache, and that ties in with the idea of hangover being an inflammatory response due to immunosuppression. But then again, given that headache is one of the top symptoms of hangover it’s not very surprising that headache pills will reduce hangover symptoms.
There are a few other things that have been tried—one was [migraine drug] Tolfenamic acid, which was found to show benefits, and the herb borage was found to ease hangover symptoms. At the current moment there have been a number of studies looking at different treatments. You need replication to have more confidence that they actually are effective.
What about people who claim to have folk cures for hangover, like burnt toast or pickle juice? Do you believe them?
Not usually. But the interesting thing is that one of the most effective hangover cures are ones that administer glucose. One of the other mechanisms of the hangover is to do with glucose metabolism and not having enough blood sugar. In Britain one of the most prevalent hangover cures is a big fried breakfast—fried eggs, sausages, baked beans, and all the rest—that’s well-renowned as a hangover cure in Britain, and it probably does work because there are lot of carbohydrates in that meal. And that will restore depleted sugar levels.
Do you yourself drink?
Yes, I do.
Does any of your research affect how cautious you are when you drink?
Probably not, but then again, I’m not researching the liver damage and circulatory disease problems, so directly, no, I don’t think my research does influence the amount I drink. What influences the amount I drink more is not wanting to get drunk and make a fool of myself. As a scientist, I like my brain to be working fairly well and be able to think clearly. The biggest thing that stops me from drinking is the feeling of my thinking is getting foggy—that’s what makes me drink less.
And do you get hangovers?
It’s interesting, because there is a review study that concluded that about 22 to 23% of people don’t get hangovers. I’m mostly in that category, although I get an occasional hangover, but mostly not.
On the occasions that you did have a hangover, what did you do?
Have a fried breakfast. That works wonders.