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This review provides a brief overview of key concepts in addiction medicine and provides tips and tricks as it pertains to treating patients with alcohol addiction in the setting of advanced alcohol-related liver disease (ALD). Understanding the brain disease model of addiction by both providers and patients is a vital springboard for establishing a therapeutic relationship. Despite a paucity of high-quality evidence, psychosocial treatments have withstood the test of time and still form the foundation of alcohol use disorder (AUD) treatment in advanced ALD. Despite the inescapable link between AUD) and advanced ALD, there are no FDA-approved medications for use in this special population. In this urgent subgroup, only baclofen, used off-label, has been shown to be effective for AUD in randomized controlled trials. An integrated, multidisciplinary and longitudinal approach remains the best option for the management of AUD in advanced ALD.