S1 E5: Alcohol Use Disorder Part 2: Treatment, Medications, and Managing Withdrawal w/Dr. Randal Mason

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 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.