Purpose of the Review <p>Medications for alcohol use disorder (MAUD) are strikingly underutilized. This might be partly attributable to abstinence-based models that discourage drinking reduction goals, thus limiting treatment seeking, prescribing MAUD to those with reduction goals, and the development of effective MAUD to promote drinking reduction. This review synthesizes evidence on MAUD (e.g., mechanisms of action, efficacy for abstinence and drinking reduction, patient predictors of response) to inform drinking goal-aligned pharmacotherapy recommendations.</p> Recent Findings <p>Evidence from recent empirical research and meta-analyses suggests that naltrexone and topiramate are well-suited to supporting drinking reduction goals, whereas acamprosate and disulfiram may be more effective for abstinence. Evidence for gabapentin was inconclusive. Patient-level factors, such as motivations for alcohol use, may also influence response.</p> Summary <p>Combating strict abstinence-based models could increase MAUD utilization by encouraging treatment-seeking, broadening the patient population offered MAUD, and expanding treatment options. Future research should incorporate treatment goals as predictors of response, investigate novel agents for drinking reduction, and evaluate whether provider education on harm-reduction approaches increases MAUD utilization.</p>