Hangover

HANGOVER, a symptom complex that occurs in alcoholics after a relatively short period following the cessation of acute intoxication phenomena. The manifestations of hangover after moderate consumption of alcoholic beverages or small doses of alcohol are limited only to distressing physical condition, general malaise, nausea, and a definite aversion to further alcohol consumption. The situation is different in chronic alcoholism. Here, as the alcohol 'history' increases, this symptom complex gradually acquires the character of true withdrawal phenomena: there is a strong craving for further alcohol consumption - to 'drink again'; there is marked tremor, profuse sweating, and a number of other autonomic disorders; depressed mood, accompanied at times by fearfulness and a tendency to unstable and unsystematized delusional formations, mainly of persecution and relationship; severely disturbed sleep with anxious dreams, the specific feature of which is their fantastic character. The entire symptom complex can vary considerably depending on the personality characteristics of the patient, for example, acquiring a paranoid coloration in schizoid alcoholics, often with the presence of auditory hallucinations in waking state, giving epileptiform seizures to epileptics, organic patients, and certain psychopaths, etc. On average, the manifestations of hangover last 1-3 days, extending in severe cases to a week or more. Characteristic in this is the irresistible craving to 'drink again,' and this latter, even for a relatively short period, alleviates or completely eliminates all the described severe phenomena. Thus, the occurrence of hangover, similar to the appearance of withdrawal symptoms in other drug addictions, should be considered a very serious diagnostic sign; to a certain extent, hangover can serve as a specific symptom of chronic alcoholism and in any case worsens the course of the latter. Of theoretical interest is the striking similarity between the manifestations of hangover and the most important psychosis of chronic alcoholism - delirium tremens (see Alcoholism - alcohol and health); these include tremor, autonomic disorders, insomnia, paranoid attitude, the nature of dreams, which often during hangover copy the usual well-known experiences of delirious patients. The absence in hangover of signs of marked clouding of consciousness, characteristic of any delirium, sharply distinguishes the two pictures. However, as alcoholism intensifies, hangover begins to acquire an increasingly severe character, in addition to specific dreams, hypnagogic hallucinations of similar content appear, and then true hallucinations; in a number of cases, alcoholic hangover quite closely approaches in picture to abortive delirium.