A 52-year-old man with severe alcohol use disorder presents for outpatient psychiatric care. He has been drinking a fifth of vodka daily for three years and has had two medically supervised detoxifications but returned to heavy drinking within weeks of each. He explicitly states he is not ready to commit to abstinence but acknowledges that his drinking is causing liver problems and marital conflict. His PMHNP proposes a treatment framework that accepts his current position, collaboratively sets a goal of reducing consumption to levels causing less medical and social harm, and uses his stated concerns about his health and marriage as motivators for incremental change while keeping the door open for eventual abstinence.