To determine the pattern and extent of prescribing of medications for alcohol relapse prevention (ARP) in England. Cross-sectional. Specialist drug and alcohol treatment providers in England reporting to the National Drug Treatment Monitoring System. Service users aged 18+, with alcohol the primary substance of dependence, completing a treatment journey between April 2013 and March 2016 (n=188 152). Prescription of medications for ARP during a treatment journey. Data on service users' demographics, treatment and clinical characteristics were extracted. The rate of prescribing medications for ARP was 2.1% in 2013/14, 6.8% in 2014/15 and 7.8% in 2015/16. A greater likelihood of prescription was associated with treatment journey year [2014/15; adjusted odds ratio (aOR)=3.269, 95% confidence intervals (CI)=3.044-3.510, 2015/16; aOR=3.823, CI=3.560-4.106], age (25-34; aOR=1.622, CI=1.380-1.907, 35-54; aOR=1.901, CI=1.628-2.220 or 55+; aOR=1.700, CI=1.446-1.999), female gender (aOR=1.129, CI=1.077-1.184), white ethnicity (aOR=1.219, CI=1.077-1.380), regional prevalence of alcohol dependence (middle rate; aOR=1.121, CI=1.024-1.228), severity of alcohol dependence (moderate dependence without complex needs; aOR=1.329, CI=1.244-1.419, severe dependence without complex needs; aOR=1.308, CI=1.188-1.441, moderate/severe dependence with complex needs; aOR=1.131, CI=1.020-1.255), treatment setting (inpatient; aOR=10.512, CI=9.950-11.104, primary care; aOR=2.264, CI=2.050-2.500, residential; aOR=3.216, CI=2.807-3.685), prior treatment for alcohol dependence (aOR=1.242, CI=1.183-1.304), longer treatment journey (aOR=1.002, CI=1.002-1.002), more drinking days in the prior 28days (aOR=1.021, CI=1.018-1.024) and drinking a higher number of alcohol units in the prior 28days (aOR=1.002 CI=1.001-1.004). Living in a region of England with the lowest alcohol prevalence was associated with a lower likelihood of prescription of medication for aRP (AOR=0.491, CI=0.436-0.552). In England, medications for alcohol relapse prevention are rarely prescribed (e.g. 7.8% in 2015/16) and those prescriptions appear to be associated with specific service user demographics, treatment and clinical characteristics.