A Review of the Literature on the Cognitive Effects of Alcohol Hangover

Richard Stephens; Jonathan Ling; Thomas M. Heffernan; Nick Heather; Kate Jones


Alcohol Alcohol. 2008;43(2):163-170. 

In This Article

Naturalistic Alcohol Consumption

Using an alternative approach, three studies have investigated the cognitive consequences of hangover subsequent to more naturalistic consumption, i.e. after participants have been allowed to drink what and sometimes where they choose. One of these showed decrements on several tests of attention - but, as zero BAL at testing was not confirmed, these could be due to acute alcohol intoxication rather than hangover effects (Anderson and Dawson, 1999). McKinney and Coyle (2004) used a related design with n = 48 and found impairments for free recall of a word list, delayed recognition of words in the list, and both simple and complex reaction times. Testing was carried out at least 7 hours after reported consumption of an average of 1.6 g/kg of alcohol and BAL was zero at testing for all except two participants whose readings were very low. Finnigan et al. (2005) used a between-subjects design with n = 25 in the hangover group but showed no cognitive effects at zero BAL the morning after reported consumption of an average of 1.7 g/kg of alcohol. We estimate the power of these studies to be 0.94 and 0.47, respectively, for the detection of medium-sized effects using two-tailed hypotheses (Cohen, 1988). Therefore the absence of effects in the latter study, in common with the laboratory studies, is likely to be due to poor study sensitivity because of low statistical power.

Two further naturalistic consumption studies have assessed different aspects of driving ability during hangover. Laurell and Törnros (1983) showed impaired cone avoidance while driving a real car. Törnros and Laurell (1991) showed no difference in the ability to go as fast as possible without losing control on a driving simulator. These studies were otherwise comparable on amount of alcohol consumed, each ensured BAL was zero at testing and each used a related design with comparable n. Key aspects of the design, procedure and results of the five naturalistic drinking hangover studies conducted to date are summarized in Table 3 and Table 4 .

In keeping with the laboratory studies reported earlier, naturalistic consumption studies indicate that hangover affects aspects of long-term memory and attention, as well as psychomotor tasks. Although the quantity of alcohol reportedly consumed in these naturalistic studies appears to be similar to that administered in the laboratory studies, consumption data reported in the naturalistic studies are averages. Therefore, some participants would have drunk substantially more in the naturalistic studies than would ethically be allowed in the laboratory. While this undoubtedly contributes to the sensitivity of naturalistic studies, there is a substantial problem in the interpretation of these results. In these studies participants were always informed at the outset that hangover effects were to be assessed and they knew which was the hangover condition. Under these circumstances expectancy effects are likely to have significantly contaminated the results. Therefore, while naturalistic alcohol consumption studies can be considered as being suggestive of hangover effects they should not, on their own, be interpreted as providing definitive evidence of hangover effects.


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