Temporal pattern in consumption of the first drink of the day in alcohol-dependent persons.

Loss of control over drinking and the craving for alcohol are cardinal signs of alcohol dependence. Our clinical practice indicates that these cravings do not occur randomly during the day, but at the same times each day for the same patient. To validate this hypothesis that alcohol-dependent patients have a circadian rhythmic craving in their desire for their first drink of the day, we asked 217 persons diagnosed as alcohol-dependent according to DSM-IV criteria to complete a questionnaire that surveyed whether this craving occurred at a fixed time each day. Of the respondents, 82% reported it did; 87% of them could state the time of day they consumed their first daily drink; and 80% reported that the time of their first drink of the day did not vary much from one day to the next. The most frequent time of consuming the first drink of alcohol was between 09:00 and 11:00 h, and it was independent of the subjects' sleep-wake routine (the delay between the hours of wake-up and the time of the first urge for alcohol was 3:45 +/- 3:30 h) and lunch or dinner time. This rhythmicity seems to be a pertinent criterion for alcohol dependence syndrome.