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It has become imperative that surface and groundwater resources be managed as a holistic system. This study applies a coupled groundwater-surface water (GW-SW) model, SWAT-MODFLOW, to study the hydrogeological conditions and the potential impacts of climate change and groundwater withdrawals on GW-SW interactions at a regional scale in western Canada. Model components were calibrated and validated using monthly river flow and hydraulic head data for the 1986-2007 period. Downscaled climate projections from five General Circulation Models (GCMs), under the RCP 8.5, for the 2010-2034 period, were incorporated into the calibrated model. The results demonstrated that GW-SW exchange in the upstream areas had the most pronounced fluctuation between the wet and dry months under historical conditions. While climate change was revealed to have a negligible impact in the GW-SW exchange pattern for the 2010-2034 period, the addition of pumping 21 wells at a rate of 4680 m(3)/d per well to support hypothetical high-volume water use by the energy sector significantly impacted the exchange pattern. The results showed that the total average discharge into the rivers was only slightly reduced from 1294 m(3)/d to 1174 m(3)/d; however, localized flowrate differences varied from under 5 m(3)/d to over 3000 m(3)/d in 320 of the 405 river cells. The combined potential impact is that intensive groundwater use may have more immediate effects on river flow than those of climate change, which has important implications for water resources management and for energy supply in the future.