Alcohol use disorders (AUD) cause significant morbidity and mortality worldwide, but pharmacological treatments for them are underused, despite evidence of efficacy.Acamprosate, naltrexone, nalmefene and disulfiram are all approved in one or more region for the treatment of alcohol use disorders. Baclofen currently has a temporary indication in France. Safety considerations for using psychopharmacological treatments in this patient group include the impact of concurrent alcohol consumption at high levels, multiple physical comorbidities which may interfere with pharmacological effects, distribution and metabolism, and concomitant medication for the treatment of comorbid physical and psychiatric conditions. The five drugs, including an extended-release injectable suspension of naltrexone, have different safety profiles which need to be balanced with the objective of treatment (initiation or continuation of abstinence, or reduction of drinking), individual patient preferences and comorbid conditions. Appropriate treatment will be based on the unique riskbenefit profile in each case. KEY POINTS Acamprosate has an excellent safety profile and is recommended as first line treatment for patients wishing abstinence. Naltrexone and nalmefene are contraindicated with opioid-containing medication, but have reasonable tolerability  The disulfiram-alcohol reaction is integral to its use, but careful patient selection and monitoring can mitigate safety risks  Baclofen is a CNS depressant so there are potential concerns regarding overdose: it may have a role in patients with severe liver disease Pharmacological treatments for alcohol dependence 3

AimsAdvances in technology have led to an increased range of possibilities for forms of mutual aid in addictions, and patient empowerment in the management of long-term conditions. However, the effective processes involved may be different online than for those that meet in person. Soberistas is a ‘social network site for people who are trying to resolve their problematic drinking patterns’. We aim to describe the population, component parts and processes that define this online community, and consider potential mechanisms of action for future research.MethodsCross-sectional online survey through an advert embedded within the Soberistas website. Participants were asked questions about themselves, their alcohol use and use of the website.ResultsFour hundred and thirty-eight people completed the survey, primarily women, 50% of whom lived with their children. Over 60% described having problematic alcohol use for over 10 years and 46.5% had not tried any form of previous support. Participants accessed the site at different stages of change; over half still drinking alcohol, cutting down or recently stopped. Over 18% reported abstinence of over 1 year. Anonymity, the ability to be honest, being a source of trusted information, and ongoing support were all cited as reasons for continued membership.Conclusion Soberistas offers a form of mutual aid primarily for women who have often not engaged with other treatment or support. This preliminary study suggests that the online, flexible, platform affords members an accessible and anonymous community to address their difficulties and encourages a positive ‘alcohol free’ identity.Short Summary Soberistas is ‘an online community of people who are trying to resolve their problematic drinking patterns’. Preliminary data suggest that it offers a flexible platform for mutual aid primarily for women who have often not engaged with other treatment or support, by encouraging a positive ‘alcohol free’ identity.

Engagement with online mutual aid might support recovery by affording users the opportunity to construct and adjust their identities in relation to their problematic alcohol use; individuals can use the parameters of being online to protect their identity, but also as a mechanism to change and consolidate their offline alcohol-related identity.

ObjectiveThis study aimed to explore women's views about breast cancer risk and alcohol use, to inform the design of a prototype for an intervention in breast clinics about alcohol as a modifiable risk factor for breast cancer.MethodsWomen recruited in NHS breast screening and symptomatic clinics in Southampton, UK, were invited to take part in semi‐structured telephone interviews or a focus group to discuss their perspectives of breast cancer risk, alcohol consumption and their information needs about these topics. Data were analysed thematically. Twenty‐eight women took part in telephone interviews, and 16 attended one of three focus groups.ResultsWhile most women reported a personal responsibility for their health and were interested in advice about modifiable risk factors, few without (or prior to) experience of breast symptoms independently sought information. Many considered alcohol advice irrelevant as the association with breast cancer was largely unknown, and participants did not consider their drinking to be problematic. Women reported trusting information from health organisations like the NHS, but advice needs to be sensitive and non‐blaming.ConclusionNHS breast screening and symptomatic clinics offer a “teachable moment” to engage women with context‐specific advice about alcohol and cancer risk that, if targeted correctly, may assist them in making informed lifestyle choices.

Background Alcohol-related presentations to acute hospitals in the UK are increasing, but little is known of the clinical characteristics or natural history of this patient group. Aims To describe the clinical characteristics, drinking profile and trajectory of a cohort of patients with alcohol use disorder (AUD) attending hospital, and explore participant perspectives of the impact of hospital attendance on their relationship with alcohol. Method We conducted a mixed method, prospective, observational cohort study of patients with AUD seen in an acute hospital. Participants were interviewed with a range of questionnaires at baseline and followed up on at 6 months. A subsample also completed in-depth qualitative interviews. Results We recruited 141 patients; 132 (93.6%) were followed up at 6 months and 26 completed qualitative interviews. Of the 141 patients, 60 (42.6%) stated the index hospital episode included the first discussion of their alcohol use in a secondary care setting. Most rated discussion of their alcohol use in hospital as ‘very positive’ or ‘positive’ (102/141, 72.3%), but lack of coordinated care with community services undermined efforts to sustain change. At 6 months, 11 (7.8%) patients had died, but in those who survived and completed assessment (n = 121), significant and clinically meaningful improvements were seen across a range of outcomes, with 55 patients (45.5%) showing a favourable drinking outcome at 6 months. Conclusions Patients with AUD have high levels of morbidity and mortality, yet many made substantial changes following intervention in hospital for their alcohol use. Prospective trials need to identify the effect of alcohol care teams in optimising this ‘teachable moment’ for patients.