Intervention: Disulfiram
Trial phase: Phase 4
ATC code: N07BB01 | P03AA04 | P03AA54
SMILES: CCN(CC)C(=S)SSC(=S)N(CC)CC
Sex: All
Age groups: Adult
Healthy volunteers: No
Participants at risk: 7
Group description: Patients in this arm will receive disulfiram 250 mg daily for a total of 42 days.

Disulfiram: Patients will be hospitalized on an inpatient psychiatric unit for 1-7 days to initiate abstinence. An fMRI scan will be performed to examine neural mechanisms of alcohol motivation. Prior to discharge, patients will receive the first dose of disulfiram 500 mg. They will then attend an outpatient clinic every other day for 14 days. At each clinic visit, they will receive 500 mg of disulfiram under supervision. Another fMRI scan examining alcohol motivation will be performed. Following this, all patients will attend the clinic weekly, and will be prescribed disulfiram 250 mg daily to take at home. This will be followed followed by an optional extension of weekly visits taking disulfiram 250 mg daily for another 28 days, for a total of 70 days of disulfiram treatment.
Eligibility criteria:
Inclusion Criteria:

Between the ages of 21-60
Right-handed
Capable of giving informed consent and complying with study procedures
Reports drinking a minimum of 5 standard drinks for men or 4 standard drinks for women on at least 4 days per week on average over the past 28 days
Meets DSM-V criteria for current Alcohol Use Disorder
Seeking treatment for Alcohol Use Disorder
Agree to not seek additional treatment, apart from Alcoholics Anonymous
Willing to attempt to abstain from alcohol completely for the duration of the study
Willing to be hospitalized on a research unit for 24 hours, longer if detoxification is needed.

Exclusion Criteria:

Risk of severe alcohol withdrawal (e.g. history of seizures or delirium tremens)
Current Moderate or Severe Substance Use Disorder, other than Alcohol, Nicotine or Caffeine Use Disorders
Lifetime history of Bipolar Disorder, Schizophrenia or Schizoaffective Disorder
Any current psychiatric disorder, other than Alcohol Use Disorder, that, in the judgment of the investigator, will require treatment that will interfere with study participation.
Current severe depression (HAM-D >24) or anxiety (HAM-A >24)
Significant suicide or violence risk
Currently taking any psychotropic medications
Legally mandated to participate in treatment
History of prior treatment with disulfiram
Sufficiently socially unstable as to preclude participation (e.g. homeless)
Contraindications to disulfiram treatment (liver disease, kidney disease, cardiac disease, seizure disorder, hypothyroidism, diabetes mellitus, pregnancy or lactation, allergy to disulfiram or thiuran derivatives)
Neurological or medical conditions that would interfere with MRI scanning (e.g. history of stroke, seizure, brain tumor, brain infection, traumatic brain injury, multiple sclerosis, dementia, metal device in body, pregnancy, claustrophobia, color blindness, severe hearing impairment, weight>300 lbs., wheelchair-bound)
Currently taking medications containing alcohol, metronidazole, isoniazid, paraldehyde, phenytoin, warfarin, or theophylline.
Significant alcohol withdrawal (CIWA>8) at screening, after confirming a blood alcohol level of zero.