This paper explores women's choice of controlled drinking or abstinence goals in harm reduction treatment programs for alcohol use problems. Situated within debates about controlled or abstinence goals for alcohol use, this research project provides a specific focus on women's treatment needs. We explore evidence which reveals that women in treatment for alcohol problems often hold deeply internalized dominant social ideologies on addiction. Results demonstrate that while offered the choice of abstinence or controlled use goals, most women defined themselves as "addicts," adopted a disease metaphor of "addiction," and chose abstinence. The findings here raise questions about whether or not clients receive sufficient education about harm reduction and controlled drinking and make adequately informed choices.