Decisional Balance Worksheet: Weigh the Pros and Cons of Changing or Staying the Same

About this tool

A decisional balance worksheet is a core tool from motivational interviewing, the approach developed by William Miller and Stephen Rollnick. It rests on a respectful idea: people are usually ambivalent about changing a behavior, holding genuine reasons on both sides at once. Pretending the substance has no upsides does not help. It just makes the worksheet feel dishonest and easy to dismiss.

So this tool asks you to map four things: what you get from using or staying the same, what it costs you, what changing would cost, and what changing would give you. Naming the real benefits of the substance is not a step backward. It helps you understand what need it is meeting, so you can find other ways to meet that need rather than fighting an urge you do not understand.

When the picture is complete, the balance often tips on its own. You may notice the costs of staying the same have quietly grown, or that the reasons to change have become more personal. There is no scoring and no right answer here. The aim is simply to see the whole board clearly, so that whatever you decide, you decide it with your eyes open.

Motivational interviewing, the approach this worksheet comes from, has been studied across dozens of trials covering substance use, drinking, and other health behaviors. Reviews pooling that research have found it performs at least as well as other established approaches, and often better, particularly when someone starts out ambivalent rather than already committed to change. The decisional balance exercise is one of the specific techniques that research points to as helping move people from ambivalence toward action.

The readiness number in the last box is a snapshot, not a verdict, and it can move around from one day to the next depending on stress, sleep, or what just happened. If you want to look closer at readiness, it can help to separate how important change feels from how confident you feel that you could actually do it, since those are often different numbers. The Motivation & Confidence Ruler on this site splits those two questions apart if this worksheet leaves you wanting more detail.

If the costs in your first box are piling up and you are not sure where to start, you do not have to plan the whole change alone. A therapist who works with substance use, or a support group, can help you turn what you have written here into a realistic next step. This worksheet is a starting point for that conversation, not a substitute for it.

Reviewed by Michael Callans, MSW
Reviewed the four-box structure and prompts for fidelity to motivational interviewing and a non-judgmental tone.

References

1. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. Guilford Press; 2013.
2. Janis IL, Mann L. Decision Making: A Psychological Analysis of Conflict, Choice, and Commitment. Free Press; 1977.
3. Prochaska JO, DiClemente CC. The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Dow Jones-Irwin; 1984.
4. Lundahl B, Burke BL. The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses. Journal of Clinical Psychology. 2009;65(11):1232-1245.

Decisional Balance Worksheet FAQ