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Weigh up the pros and cons of continuing to use substances versus making a change. A core motivational interviewing technique.
Consider your substance use honestly. For each quadrant, write as many points as you can. There are no right or wrong answers \u2014 this is about exploring your own motivations and building a picture of where you stand.
Use in the motivational and early treatment phases to explore ambivalence about changing substance use. Particularly valuable for clients in the contemplation stage of change who recognise both benefits and costs of their substance use.
Normalise ambivalence — it's natural to have mixed feelings about changing a behaviour that provides some benefits alongside its costs. Frame the exercise as an honest, non-judgmental exploration of all sides, not a tool to persuade the client to change.
For clients who are pre-contemplative, focus on the 'pros of current use' first to build engagement and demonstrate the therapist's non-judgmental stance. For those who are already committed to change, use the decisional balance to consolidate motivation and prepare for moments of wavering.
Do not use the decisional balance to argue with the client or selectively emphasise the cons of use. If the balance genuinely tips toward continued use, respect this and continue motivational work rather than pushing for change the client is not ready for.
The four quadrants (pros of use, cons of use, pros of change, cons of change) often reveal that the pros of use are immediate and concrete while the cons are delayed and abstract. Help the client explore this temporal dimension. The 'cons of change' quadrant often contains the most clinically useful information about barriers to address.
Suitable for clients working with substance-misuse, motivational-interviewing, decisional-balance, ambivalence. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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A cognitive formulation of substance misuse based on Beck et al.'s (1993) model. Maps the pathway from early experiences through beliefs and automatic thoughts to substance use and its maintaining cycle.
Track urges to use substances without acting on them. Practice the skill of riding the wave of craving until it passes.
A simplified motivational tool to explore your reasons for and against changing your substance use.
Explore the triggers, thoughts, feelings, and consequences associated with substance use to understand its function in your life.