Semaglutide Dose Effects on Metabolic and Stress Hormone, Craving and Alcohol Use Outcomes

Inclusion Criteria:

* Male and females ages 18-60 and BMI in 30-49.9 kg/m2;
* regular weekly alcohol use (at least 3X/week) prior to admission;
* must meet current DSM-V criteria for moderate to severe Alcohol Use Disorders (AUDs) using SCID-I for DSM-V;
* Good health as verified by screening and physical examination;
* Able to read English and complete study evaluation;
* Able to provide informed written and verbal consent.

Exclusion Criteria:

* Meet current criteria for moderate to severe substance use disorders from abuse of any another psychoactive substance, excluding nicotine;
* Current use of opiates;
* Current use of psychiatric medications, including benzodiazepine-based sedatives/anxiolytics and anticonvulsants, non SSRI antidepressants, oral prescription analgesics (other than non-steroidal anti-inflammatory drugs), acamprosate, naltrexone, antabuse, baclofen, varenicline;
* Psychotic or otherwise severely psychiatrically disabled (i.e., suicidal, homicidal, current mania);
* Endocrine or immune disorders, including diagnosis of diabetes (T2D or T1D) by American Diabetes Association (ADA) criteria or a history of HgbA1c \>6.5% and on current medications for T2D treatment;
* Significant underlying medical conditions, including history of pancreatitis, acute kidney injury, medullary thyroid cancer, or MEN syndrome, as well as other cerebral, renal, thyroid or cardiac pathology that would preclude study participation;
* Current use of any anti-obesity medications;
* Prior history of bariatric surgery or current intragastric balloon;
* Current participation in structured meal replacement or weight loss program;
* Weight loss of \>=10% over the preceding 6 months;
* Women who are pregnant, nursing or refuse use of reliable form of birth control.