In this second episode of a two-part series on Alcohol Use Disorder (AUD) in British Columbia, addiction medicine physician Dr. Randal Mason returns to dive deeper into the practical realities of treatment. He challenges the traditional "all-or-nothing" view of recovery, explaining how harm reduction and patient-defined goals are reshaping clinical approaches. Dr. Mason walks through evidence-based pharmacological options — including naltrexone, acamprosate, gabapentin, and topiramate — and makes the case that these medications are safe and effective enough to be managed in primary care settings. The conversation also covers the complexities of alcohol withdrawal, how to use the CIWA score to determine appropriate level of care, and when outpatient withdrawal management is a reasonable option. Throughout, Dr. Mason emphasizes the importance of combining pharmacotherapy with motivational interviewing, patient goal-setting, and realistic hope — even in the most challenging cases. © UBC Faculty of Medicine All Rights Reserved
Guest: Dr. Randal Mason
Host: Dr. Chris Morrow
Producer: Craig Ferguson
Music: "Stand With Me" by Adrian Walther licensed via SoundStripe
Episode Timestamps
[00:00] – Introduction and episode overview
[00:58] – Rethinking the abstinence-only model: harm reduction and patient-defined goals
[03:04] – How reduced drinking can meaningfully lower health risks
[04:08] – When abstinence remains the right goal
[05:04] – Pharmacological approaches: naltrexone and acamprosate
[06:37] – Choosing between naltrexone and acamprosate
[07:24] – Are anti-craving medications underutilized in primary care?
[09:28] – Other options: gabapentin, topiramate, and psychosocial supports
[10:36] – Multimodal treatment: combining pharmacotherapy with motivational interviewing
[11:04] – Effectiveness of anti-craving medications and reasons for hope
[12:38] – Addressing clinician nihilism and burnout around AUD
[14:13] – Alcohol withdrawal: identifying risk and using the PAWSS score
[15:35] – Outpatient vs. inpatient withdrawal management
[17:37] – Gabapentin as a withdrawal management tool
[18:37] – Detox: common misconceptions and finite resources in BC
[20:06] – Personalizing the withdrawal and detox plan to patient goals
[21:44] – A difficult scenario: rural ED, no detox beds, patient wants to go home
[24:13] – Practical middle-ground approaches for harm reduction
[25:02] – Closing reflections and final thoughts from Dr. Mason
[26:50] – Knowledge nugget: animals and alcohol
[27:51] – Credits and CME information
Studies & Research Mentioned
Province of British Columbia. High-Risk Drinking and Alcohol Use Disorder. BC Guidelines; 2024. Accessed January 29, 2026. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/high-risk-drinking-and-alcohol-use-disorder
Wood E, Bright J, Hsu K, et al; Canadian Alcohol Use Disorder Guideline Committee. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023;195(40):E1364–E1379. doi:10.1503/cmaj.230715. https://www.cmaj.ca/content/195/40/E1364
Canadian Centre on Substance Use and Addiction (CCSA). Canada's Guidance on Alcohol and Health. 2023. Accessed January 29, 2026. https://www.ccsa.ca/en/guidance-tools-resources/substance-use-and-addiction/alcohol/canadas-guidance-alcohol-and-health
BC Centre on Substance Use; Canadian Institute for Substance Use Research. Canadian Operational Guidance: Managed Alcohol Programs. Appendix 9: Alcohol Use Disorder Screening and Assessment Tools. BCCSU; 2023. Accessed January 29, 2026. https://www.bccsu.ca/wp-content/uploads/2023/07/Resource-Alcohol-Use-Disorder-Screening-and-Assessment-Tools.pdf
UBC Continuing Professional Development. Alcohol Use: Screening, Determining Risk, and Evidence-Based Treatment. Accessed January 29, 2026. https://ubccpd.ca/learn/learning-activities/course?eventtemplate=724-alcohol-use-screening-determining-risk-and-evidencebased-treatment
© UBC Faculty of Medicine All Rights Reserved