Off-Label Medications for Alcohol Use Disorder Among Patients With HIV: Pilot Study 1 (HARP)

Inclusion Criteria: diagnosed with HIV Receive care at the Atlanta VA Healthcare System Age 18 or over Meet criteria for moderate to severe alcohol use disorder by the DSM-5 Alcohol Symptom Checklist Score >7 on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen Have evidence of significant alcohol use: PEth > 20ng/ml Prescribed >=5 medications Have cell phone or reliable contact number Can provide written informed consent Exclusion Criteria: Active engagement in formal alcohol treatment including medications for alcohol use disorder at the time of enrollment Self-report or laboratory test confirming pregnancy, nursing, or trying to conceive Life-threatening or unstable medical, surgical, or psychiatric condition that prohibits participation (including current or past intent to harm oneself or others within the prior 12 months and not receiving treatment Untreated moderate to severe opioid use disorder Residence out of state Inability to read or understand English History of serious hypersensitivity or adverse reaction to study medication Taking potentially interactive medication(s): eplerenone, potassium supplementation, lithium, digoxin, cholestyramine, heparin and low-molecular weight heparin for spironolactone) Hyperkalemia defined as serum potassium ≥ 5.0 mEq/L on the most recent laboratory test performed in the past 60 days prior to enrollment or Addison's disease or estimated glomerular filtration rate <50 mL/min/1.73 m2 (for spironolactone) Creatinine level of ≥1.5 mg/dl (for spironolactone) Already prescribed the pilot medication at the time of study recruitment.