Behavioral and circadian correlates of relapse in alcohol use disorder: The roles of impulsivity, craving, and chronotype

ABSTRACT Background: Relapse in alcohol use disorder (AUD) remains a major clinical challenge, influenced by a combination of behavioral and biological factors. While impulsivity and craving have been widely studied, the role of chronotype—a marker of circadian preference—has received limited attention, particularly in Indian populations. Aim: To examine the influence of trait impulsivity, craving intensity, and chronotype preference on relapse outcomes in patients with AUD. Materials and Methods: Eighty-one individuals with AUD were assessed using the Barratt Impulsiveness Scale-11, Penn Alcohol Craving Scale, and Composite Scale of Morningness (CSM) at baseline and followed up for three months. Participants were categorized as abstinent, reduced consumption, or relapsed based on the self-reported alcohol use. Between-group comparisons and logistic regression analyses were performed to identify predictors of relapse. Results: Relapsed participants exhibited higher total impulsivity (71.82 ± 8.20), stronger craving (23.12 ± 3.16), and lower CSM scores (26.09 ± 3.36), indicating greater eveningness. Craving ( B = 0.43, P = 0.007, odds ratio [OR] = 1.53) and evening chronotype ( B = –0.30, P = 0.020, OR = 0.74) significantly predicted relapse, while impulsivity showed a non-significant positive trend. Conclusion: Craving intensity and evening chronotype emerged as robust independent predictors of relapse, with impulsivity contributing indirectly through their interplay. Incorporating chronobiological assessment and rhythm-stabilizing interventions—such as social rhythm therapy and circadian-zeitgeber approaches—may strengthen relapse-prevention efforts in AUD.