Suvorexant for Alcohol Use Disorder (AUD): Neural Mechanisms

Study Description: This protocol examines effects of a 10-28 day course of suvorexant treatment on brain dopamine receptors, brain reactivity to cues and symptomatology in individuals with alcohol use disorder (AUD) undergoing detoxification. We hypothesize that suvorexant compared to placebo will (1) increase striatal dopamine D2 receptors while decreasing the balance of D1 to D2 receptor signaling (D1R/D2R) and (2) improve sleep and reduce alcohol craving and dysphoria. Objectives: Primary objectives: To examine the impact of suvorexant on dopamine receptors in adults with AUD undergoing detoxification and to compare against baseline measures in healthy controls. Secondary objectives: To examine suvorexant's effects on sleep quality and alcohol craving in adults with AUD undergoing detoxification. Endpoints: Primary Endpoint: Suvorexant's effects on brain dopamine receptors: -Striatal dopamine D1 and D2 receptor availabilities and D1R/D2R ratios Secondary Endpoints: Effects of suvorexant on: * N3, REM, and total sleep duration (assessed with polysomnography) * Self-reports of sleep quality * Self-reports of alcohol craving and mood Exploratory Endpoints: * Brain structure, function, chemistry and cerebrospinal fluid (CSF) dynamics as assessed by MRI (task and resting fMRI, MRS, structural MRI, and diffusion tensor imaging or DTI) * Cognitive Test Performance