Predictors of hangover during a week of heavy drinking on holiday Morten Hesse & Sébastien Tutenges University of Aarhus, Centre for Alcohol and Drug Research, Copenhagen Division, Copenhagen S, Denmark ABSTRACT Aims To investigate predictors of hangover during a week of heavy drinking in young adults. Design Observational prospective study. Methods A total of 112 young Danish tourists were interviewed on three occasions during their holiday. They completed the Acute Hangover Scale and answered questions about their alcohol consumption and rest duration. The incidence of hangover was analysed as the proportion of heavy drinkers (i.e. those reporting drinking more than 12 standard units of alcohol during the night before) scoring above the 90th percentile of light drinkers (i.e. those who had consumed fewer than seven standard units the night before). We estimated the course and predictors of hangover using random effects regression. Results The incidence of hangover was 68% after drinking more than 12 standard units in the whole sample. The severity of hangover increased significantly during a week of heavy drinking and there was a time ¥ number of drinks interaction, indicating that the impact of alcohol consumed on hangover became more pronounced later in the week. Levels of drinking before the holiday did not predict hangover. Conclusions Hangovers after heavy drinking during holidays appear to be related both to amount drunk and time into the holiday. Keywords Binge drinking, hangover, heavy drinking, nightlife tourism, prospective study, youth. Correspondence to: Morten Hesse, University of Aarhus, Centre for Alcohol and Drug Research, Copenhagen Division, Artillerivej 90, 2nd, DK-2300 Copenhagen S, Denmark. E-mail: mh@crf.au.dk Submitted 16 June 2009; initial review completed 17 August 2009; final version accepted 23 September 2009 INTRODUCTION Alcohol problems contribute significantly to the global burden of illness, and form the ninth leading cause of attributable mortality world-wide [1]. The developmental course of alcohol use disorders is diverse, and is influ- enced by both socio-demographic, gender, cultural and genetic factors [2]. Drinking alcohol has both long-term and acute effects. In lay terms, the acute after-effects of alcohol consump- tion are known as ‘hangover’ in English. This ‘alcohol hangover’ is a cluster of symptoms that is believed to develop when blood alcohol concentration returns to zero and is characterized by a feeling of general misery, with symptoms such as headache, tiredness and nausea that may last 24 hours or more [3–5]. Although a large number of scientific studies have been conducted on the general health effects of alcohol consumption, until recently researchers have almost completely neglected the alcohol hangover [3]. The incidence of hangover There is limited information on the incidence of hangover but, based on a few published surveys, approximately three out of four people report that they have experienced hangover after a night of excessive drinking [4]. Most previous research [4] has used self-reported occurrence of hangover with no control standard. Similarly, surveys of both young drinkers [6] and adult drinkers [7] have generally used simple yes/no items to assess the incidence of hangover. There are important limitations to this approach. As is the case with any single-item measure- ments, items may be interpreted differently by different subjects. The term ‘hangover’ may, for some, denote a debilitating condition, but for others denote the mere presence of any detectable after-effect that is perceived to be the result of alcohol intake. Attribution bias may also influence the findings. Some respondents may attribute the after-effects to other factors, such as lack of sleep, and therefore do not report hangover even if they experience RESEARCH REPORT doi:10.1111/j.1360-0443.2009.02816.x © 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction Addiction, 105, 476–483