The Assessment of Overall Hangover Severity

Abstract

The aim of this study was to critically evaluate and compare the different methods to assess overall hangover severity. Currently, there are three multi-item hangover scales that are commonly used for this purpose. All of them comprise a number of hangover symptoms for which an average score is calculated. These scales were compared to a single, 1-item scale assessing overall hangover severity. The results showed that the hangover symptom scales significantly underestimate (subjective) hangover severity, as assessed with a 1-item overall hangover severity scale. A possible reason for this could be that overall hangover severity varies, depending on the frequency of occurrence of individual symptoms included in the respective scale. In contrast, it can be assumed that, when completing a 1-item overall hangover scale, the rating includes all possible hangover symptoms and their impact on cognitive and physical functioning and mood, thus better reflecting the actually experienced hangover severity. On the other hand, solely relying on hangover symptom scales may yield false positives in subjects who report not having a hangover. When the average symptom score is greater than zero, this may lead to non-hungover subjects being categorized as having a hangover, as many of the somatic and psychological hangover symptoms may also be experienced without consuming alcohol (e.g., having a headache). Taken together, the current analyses suggest that a 1-item overall hangover score is superior to hangover symptom scales in accurately assessing overall hangover severity. We therefore recommend using a 1-item overall hangover rating as primary endpoint in future hangover studies that aim to assess overall hangover severity.

Keywords: alcohol; hangover; measurement; scale; severity; single item assessment; symptoms.

Figure 1

Presence and severity of symptoms included in hangover symptom scales. Data from n = 1837 social drinkers who reported on their latest past month hangover [4]. Note: “sensitivity to sound” was not assessed. Abbreviations: HSS = Hangover Symptoms Scale, AHSS = Alcohol Hangover Severity Scale, AHS = Acute Hangover Scale.

Figure 2

Impact of hangover symptoms on cognitive and physical functioning and mood. Negative impact of hangover symptoms cognitive functioning (A), physical functioning (B), and mood (C) was rated on scales ranging from 0 (absent) to 5 (extreme). Note: “sensitivity to sound” was not assessed and “trouble sleeping” was excluded as not being a true hangover symptom. Data from reference [4].

Figure 3

Presence and severity of symptoms related to alcohol hangover. Note: In contrast to the original AHS, scores range from 0 (absent) to 10 (extreme). Data from reference [19].

Figure 4

Level of subjective intoxication and alcohol consumption and corresponding next day hangover symptom severity reported on two different test days by the same subjects. Individual subject ratings for 1-item overall hangover severity (A), the AHS score (B), individual symptom scores (C–J), the amount of alcohol consumed the evening before having the hangover (K), and the corresponding level of subjective intoxication (L) are shown.

Figure 5

Test–retest reliability. Spearman’s correlations are shown. Higher scores suggest a better test–retest reliability. Bootstrapping (n = 10.000 samples, bias corrected 95% confidence interval) was applied to adjust correlations for the small sample size. An acceptable test–retest reliability is demonstrated if Spearman’s correlation > 0.7 [21].

Figure 6

AHS and symptom severity scores for two days on which an equal amount of alcohol was consumed within subjects. Significant differences (p < 0.05) between the two days are indicated by an asterisk (*). Abbreviation: AHS = acute hangover scale.