In this second episode of a two-part series on Alcohol Use Disorder (AUD) in British Columbia, addiction medicine physician Dr. Randal Mason returns to dive deeper into the practical realities of treatment. He challenges the traditional "all-or-nothing" view of recovery, explaining how harm reduction and patient-defined goals are reshaping clinical approaches. Dr. Mason walks through evidence-based pharmacological options — including naltrexone, acamprosate, gabapentin, and topiramate — and makes the case that these medications are safe and effective enough to be managed in primary care settings. The conversation also covers the complexities of alcohol withdrawal, how to use the CIWA score to determine the appropriate level of care, and when outpatient withdrawal management is a reasonable option. Throughout, Dr. Mason emphasizes the importance of combining pharmacotherapy with motivational interviewing, patient goal-setting, and realistic hope — even in the most challenging cases. © UBC Faculty of Medicine All Rights Reserved