Pros and Cons of Change

When to Use

Use in the motivational phase alongside or instead of the decisional balance. This structured pros and cons analysis specifically examines the costs and benefits of making a change versus staying the same, helping consolidate motivation and identify barriers.

How to Introduce

Present as a thorough examination of what could be gained and lost by changing substance use patterns. Emphasise that this is the client's analysis — the therapist's role is to help them explore each quadrant thoroughly, not to advocate for a particular conclusion.

Adaptations

For clients considering reduction rather than abstinence, frame the change being examined accordingly. For those in the maintenance stage, use to remind them of their reasons for change and to anticipate challenges. For clients with cognitive difficulties, use verbal discussion and therapist-recorded notes rather than written completion.

As with the decisional balance, avoid using this exercise coercively. If the client's honest analysis does not support change at this time, respect this and continue building motivation through exploring discrepancies between values and behaviour.

Clinical Tips

The pros of staying the same often map onto the function of substance use (stress relief, social connection, identity). These functions need to be addressed in treatment — the client needs alternative ways to meet these needs. The cons of change often reveal fears about coping without substances that can be tested through behavioural experiments.