AIM:To examine the socioeconomic differences in the effectiveness of alcohol use disorders (AUD) pharmacotherapy and risk of AUD hospitalisation.

DESIGN: A prospective register-based cohort study.

SETTING: Sweden.

PARTICIPANTS Individuals who were registered as living in Sweden in 2005 (16-64 years) with a first-time AUD diagnosis and complete information on their socioeconomic position (SEP) between 2005 and 2019 (n = 148 626).

MEASUREMENT: The outcome was AUD hospitalisation. The use of AUD pharmacotherapy was treated as a time-varying exposure. SEP was the moderator. The association between the joint-exposure (pharmacotherapy use and SEP) and AUD hospitalisation was assessed using a competing-risk regression model, adjusted for sociodemographic factors, previous mental health diagnoses and use of other psychiatric medications.

FINDINGS: Pharmacotherapy use was associated with a lower risk of AUD hospitalisation among high SEP individuals [subdistribution hazard ratio (SHR) = 0.83, 95% confidence interval (CI) = 0.77-0.90], but not among those with low SEP (SHR = 1.02, 95% CI = 0.94-1.10) and middle SEP (SHR = 1.01, 95% CI = 0.94-1.09), compared with low SEP individuals when not using pharmacotherapy.

CONCLUSIONS: In Sweden, alcohol use disorder (AUD) pharmacotherapy appears to be effective to reduce the risk of AUD hospitalisation only among individuals of high socioeconomic position.