Spironolactone in Alcohol Use Disorder (SAUD)

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• Known history of prior hypersensitivity reaction to spironolactone or other MR antagonists, or any of the product components
• Physical and/or mental health conditions that are clinically unstable, as determined by the study clinicians, including (but not limited to) major depressive disorder or generalized anxiety disorder unstable during the past three months or other psychiatric conditions (e.g., schizophrenia, bipolar disorder) unstable during the past twelve months prior to screening
• Known history of clinically significant orthostatic hypotension
• Known history of hypoaldosteronism, hyperaldosteronism, Addison s disease
• Diagnosis of NYHA class III-IV heart failure, or unstable cardiovascular conditions (e.g., arrhythmias, clinically significant ECG abnormalities)
• Known history of alcohol withdrawal seizure and delirium tremens
• Any other reason or clinical condition that the Investigators judge would interfere with study participation and/or be unsafe for a participant
• Most recent blood tests: potassium > 5.2 mmol/L; creatinine >= 2 mg/dL; eGFR < 60 mL/min/1.73 m\^2, hemoglobin A1c (HbA1c) > 6.5 %
• Current use of any diuretic, angiotensin receptor blocker (ARB), angiotensin converting enzyme inhibitor (ACEI), potassium supplementation, potassium containing salt substitute, heparin and low molecular weight heparin (LMWH), trimethoprim, lithium, digoxin, cholestyramine
• An individual who meets any of the following criteria will be excluded from participation in this study:
• Clinically significant and/or symptomatic hyponatremia, hypomagnesemia, hypocalcemia, and hyperuricemia based on Medical Advisory Investigators (MAI) or designee judgment
• Current use of MR antagonists
• Current use of FDA-approved pharmacotherapy for AUD, or seeking treatment for AUD
• Pregnancy, intention to become pregnant, or breastfeeding

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• INCLUSION CRITERIA:; In order to be eligible to enroll in this study, an individual must meet all of the following criteria:
• At least 21 years old
• Alcohol Use Disorder (minimum 2 symptoms on a validated diagnostic tool, e.g., the Mini- International Neuropsychiatric Interview (MINI) or the Structured Clinical Interview for DSM Disorders (SCID))
• At least four days with >= 4 drinks for females or >= 5 drinks for males during the 28-day period prior to screening, according to alcohol TimeLine Follow Back (TLFB)
• Most recent Clinical Institute Withdrawal Assessment for Alcohol - revised (CIWA-Ar) score is < 10
• Able to speak, read, write, and understand English as demonstrated by their ability to understand and sign the consent for the NIDA screening protocol
• Female participants must be postmenopausal for at least one year, surgically sterile, or practicing a highly effective method of birth control before entry and throughout the study and must have negative pregnancy tests at each stage. Examples of highly effective methods of birth control include abstinence, hormonal contraceptives (e.g., certain birth control pills, contraceptive patch, vaginal ring, or implants), intrauterine device (IUD), tubal ligation, or vasectomy