Is abstinence the only acceptable goal in addiction care? This Yale lesson, part of the course Addiction Treatment: Clinical Skills for Healthcare Providers, walks through four treatment goal categories clinicians can pursue with patients: use with less harm, controlled use, conditional abstinence, and complete abstinence. Using a model case performed by actors, the instructor shows how to match goals to where a patient actually stands using the five stages of change framework, then demonstrates motivational interviewing tools such as change rulers and change talk to move treatment forward collaboratively. The lesson also covers building action plans with patients and preparing for setbacks, framing addiction as a chronic, relapsing condition that still responds to individualized, patient-defined care rather than provider-imposed abstinence mandates.