Anxiety During Abstinence in AUD

This study will recruit 40 treatment-seeking participants with AUD ("AUDP") and 20 age matched healthy volunteer participants (HVP). AUDP will be initiated on disulfiram, a medication FDA approved for alcohol use disorder that is a first line treatment for maintenance of abstinence from alcohol, to facilitate and help ensure abstinence from alcohol and will undergo functional MRI scanning at two timepoints: 1) 8-14 days after the last drink ("early abstinence") and 2) after three months of abstinence ("protracted abstinence"). HVP will be scanned once. The investigators will examine the functioning of the Anterior Insula (AI), Bed Nucleus of the Stria Terminalis (BNST), and Dorsolateral Prefrontal Cortex (DLPFC) during a task that evokes anxiety while anticipating an uncertain threat ("threat-anxiety") as well as resting state functional connectivity (RSFC) between AI-BNST and AI-DLPFC to measure whether there are neuroplastic changes in these circuits that occur during abstinence. These changes in anxiety circuit activity and connectivity will be related to changes in current anxiety symptoms.

Inclusion criteria

(Participants with Alcohol use Disorder):

• Between the ages of 21 and 55
• Right-handed
• Able to perform informed consent and comply with study
• Seeking treatment for AUD
• Meets The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for AUD of at least moderate severity (>3 symptoms)

Inclusion criteria

(Healthy Volunteer Participants):

• Between the ages of 21 and 55
• Right-handed
• Able to perform informed consent and comply with study
• Report drinking an average of fewer than 8/15 standard drinks per week for women/men and no more than 1 HDD (heavy drinking days) during the previous 28 days.

Exclusion criteria

(Participants with Alcohol use Disorder):

• Neurological, medical or other conditions that would interfere with MRI scanning (e.g., history of stroke, seizure, brain tumor, brain infection, traumatic brain injury, multiple sclerosis, dementia, non MRI-compliant metal device in body, pregnancy, claustrophobia, color blindness, severe hearing impairment, weight>300 lbs., wheelchair-bound, tattoos as indicated by the guidelines established by the Zuckerman Institute MRI unit: https://mr.research.columbia.edu/
• DSM 5 diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder
• Any non-AUD psychiatric disorder that may, according to the investigator's judgment, require treatment over the course of the study
• Significant suicide or violence risk
• Currently taking psychotropic medication
• Current substance use disorder other than AUD, tobacco use disorder or mild cannabis use disorder
• Currently pregnant, attempting to become pregnant or nursing
• Sufficiently socially unstable as to preclude participation (e.g. homeless).
• Known history of allergy, intolerance, or hypersensitivity to disulfiram or its derivates
• Contraindications to disulfiram treatment (e.g. liver disease, kidney disease, cardiac disease, seizure disorder, hypothyroidism, diabetes mellitus, pregnancy or lactation, allergy to disulfiram or thiuram derivatives)
• Currently taking medications containing alcohol, metronidazole, isoniazid, paraldehyde, phenytoin, warfarin, or theophylline.
• Treatment with concomitant medications that might interfere with disulfiram
• A history of alcohol withdrawal seizures, delirium tremens or resistant alcohol withdrawal
• Current moderate or severe alcohol withdrawal (CIWA >9 with BAL<0.05)
• History of prior disulfiram treatment failure
• Being abstinent for > 7 days at the time of screening

Exclusion criteria

(Healthy Volunteer Participants):

• Neurological, medical or other conditions that would interfere with MRI scanning (e.g., history of stroke, seizure, brain tumor, brain infection, traumatic brain injury, multiple sclerosis, dementia, non MRI-compliant metal device in body, pregnancy, claustrophobia, color blindness, severe hearing impairment, weight>300 lbs., wheelchair- bound, tattoos as indicated by the guidelines established by the ZI MRI unit: https://mr.research.columbia.edu/
• DSM 5 diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder
• Any psychiatric disorder that may, according to the investigator's judgment, require treatment over the course of the study
• Significant suicide or violence risk
• Currently taking psychotropic medication
• Current substance use disorder other than tobacco use disorder or mild cannabis use disorder
• Currently pregnant, attempting to become pregnant or nursing
• Sufficiently socially unstable as to preclude participation (e.g., homeless).
• A diagnosis of AUD of any severity