I’m never drinking again: The science behind hangovers

Photo by Kevin Kramer, The Growler

Photo by Kevin Kramer, The Growler

Jonathan Howland is in the business of giving people hangovers. A professor of emergency medicine at Boston University School of Medicine and director of the Boston Medical Center Injury Prevention Center, Howland got into what he calls “the hangover business” when he and colleague Damaris Rohsenow, an alcohol and drug abuse researcher at Brown University, began studying federal safety regulations around the effects of alcohol use in safety-sensitive jobs. Seeking to learn more about how much time there should be between consuming alcohol and performing occupational tasks, what Howland calls “bottle to throttle,” they tried to figure out the best way to measure how people act on the job after a night on the town.

They created a laboratory where they could get people together and get them drunk, then test them the day after to measure their ability to pilot a plane, navigate a ship, or just bend over and tie their shoelaces. They needed to get their subjects beyond buzzed, past happily aglow, turning the corner toward toasted, and finally arriving at absolutely stinko, with breath alcohol concentrations (BrAC) at .12%. (In the United States, .08% blood alcohol concentration, which is highly correlated to BrAC, is the legal limit for driving under the influence (DUI) or driving while impaired (DWI). For commercial drivers, it’s .04%). With this goal in mind, the hangover lab was born.

A night in the hangover lab

Howland’s lab is the ultimate multi-use space: it’s a “pub,” a cozy space to sleep it off, and a morning-after no-nonsense scientific testing facility (which makes our heads hurt even thinking about it). Volunteers are drawn mostly from students at nearby Boston University, Boston College, and Harvard University. They report in at 4pm, and the first order of business is dinner.

Then they’re let loose in the lounge-like space (under the supervision of four to six staff members, of course), where Howland describes “a kind of a party atmosphere” quickly prevailing—well, among half of them, anyway, since subjects receive either real alcohol or a placebo beverage. As they’re lifting their glasses, their BrAC is monitored, and in the meantime, they’re free to play cards, watch videos, and chat up their fellow subjects (though they can’t move about the lab unattended). “We are promoting comfort and congeniality, and it turns out to be quite a pleasant experience,” Howland says.

After hitting their BrAC limit, they hit the sack, where their sleep is monitored by an EMT during the night. Bright and early at 7am, they’re roused to take occupational simulation and neurocognitive tests, including metrics on their attention-reaction time. Then they’re set free to sleep it off, having earned about $15 an hour for their efforts in getting lit in the name of advancing science.

The lucky 23 percent

With more than 10 years of tipsy-making research under his belt, Howland has learned a lot about the way excessive alcohol consumption can affect cognitive function. One of the craziest things he’s observed is that around 23 percent of people report never experiencing hangover symptoms. So if there are 10 folks receiving alcohol on any given night during one of his experiments, it’s not surprising if a couple of them rise and shine brightly the next day, exhibiting no symptoms at all, and deeply annoying their horribly hungover fellow subjects.

Here’s the thing, though: Howland can’t size up his group at the start of the night and accurately predict who those people will be. There are some factors, such as body fat or ethnic heritage, that make smaller women or people with East Asian heritage more likely to process alcohol in different ways. But it’s not yet understood what factors those lucky 23 percent possess that allow them to emerge unafflicted by the brown bottle flu.

What is happening to me?

Leave it to a brainy scientist to wrap your misery up in a box and tie it with a perky bow. Jing Liang is a neuroscientist, neuropharmacologist, and professor at University of Southern California’s School of Pharmacy. One of her areas of focus is the effect of alcohol mild dosage to overuse—everything from the night-on-the-town-gone-wrong variety to chronic Alcohol Use Disorder (AUD).

She’s got a dandily detailed description of a hangover:

The experience of various uncomfortable physiological and psychological feelings/symptoms following alcohol drinking, as found in wine, beer and distilled spirits. Typical symptoms of a hangover may include headache, concentration problems, dry mouth, dizziness, fatigue, gastrointestinal distress (such as vomiting), absence of hunger, sweating, nausea, hyper-excitability, anxiety, and sleep problems.

Thanks, doc. We’ll lie on the couch with a sweatshirt over our heads until that description passes.

While theories abound to explain the cause of hangovers—
dehydration, low blood sugar, or even a disruption of GABA neurotransmitter receptors—Howland is adamant that nobody really knows what’s going on in an over-served body: “People know the symptoms of hangovers, but we don’t know what the causes are.”

While dehydration is commonly thought to be the culprit behind this multiplicity of symptoms, Howland poo-poos that theory. “Dehydration is a symptom, because alcohol is a diuretic. The more alcohol you drink, the more dehydrated you’ll become. If dehydration were a cause of hangovers, then simply rehydrating would cure them, and that certainly isn’t the case.” With no conclusive cause for the time being, it seems that experts are sticking to the theory that a hangover is just your body reminding you that you’re an idiot.

Even if they don’t know what causes hangovers, the effects are observable not just in the body, but also on the brain. If you give a functional MRI test to a patient suffering from a hangover, Liang says, you’ll notice a marked difference in brain function. “Alcohol effects can be seen in striatal areas (hippocampus), while emotional effects can be seen in limbic areas.” Liang mentions a “robust activation of striatal reward circuits, along with attenuated response to fearful stimuli in visual and limbic regions.” In other words, in addition to feeling crappy, you’re probably more likely to be anxious, too.

A not-so-merry band

There is, amazingly, such a thing as the Alcohol Hangover Research Group (AHR). If you feel you’ve already done enough “research” to be a charter member, you’ll be disappointed to learn that this is a real-deal group of scientists, not a ragtag band of inebriates. The stated purpose of this international expert group of active researchers is “to elucidate the pathology, treatment, and prevention of the alcohol hangover.”

Despite the fact that no one can say “elucidate” three times fast while suffering from a hangover, this group is active in their increasingly attention-generating field. The group co-published a 2010 paper in the journal Current Drug Abuse Reviews pinpointing the moment when a hangover starts. If your blood alcohol concentration (BAC) gets to be at least .11%, and you’re one of the not-so-lucky 77 percent, you’ll have hangover symptoms the next day. The problems aren’t present when you’re drunk, they say: the hangover begins when BAC falls considerably and peaks when BAC returns to almost zero. This is probably why “hair of the dog” is such a popular cure, even though experts say it only delays the inevitable hangover crash.

While the group can point to the moment when a hangover starts, they all agree that the “why” is still up in the air: “At present, no theoretical model accounts for the pathology of alcohol hangover,” the study says. “There is limited understanding of various basic issues, such as what biological processes cause alcohol  hangover and whether genetics play an important role. Also, it is unclear why, despite excessive alcohol consumption, there are great individual differences in the presence and severity of alcohol hangovers.”

Next Page: Fending off hangover symptoms

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