Decisional Balance Worksheet: Weigh the Pros and Cons of Changing or Staying the Same
A decisional balance worksheet helps you weigh the benefits and costs of changing a behavior or keeping it the same, so you can clarify what matters and what support you need.
Reviewed by Michael Callans, MSW 
About this tool
A decisional balance worksheet compares the benefits and costs of changing a behavior with the benefits and costs of staying the same. It helps you put mixed feelings into words when you feel pulled toward change and also have reasons to keep doing what feels familiar. Its roots include the decision-making work of Irving Janis and Leon Mann, and it is discussed alongside motivational interviewing, developed by William Miller and Stephen Rollnick. People can hold genuine reasons on both sides at once. Naming what the substance does for you makes the worksheet more honest and useful.
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, you may notice the costs of staying the same have grown, or that the reasons to change have become more personal. You may also remain uncertain. This exercise does not guarantee a decision or make change happen on its own. There is no total score or right answer here. The aim is to see your options clearly enough to identify what information, practical help, or conversation would make your next step more manageable.
The evidence needs an important distinction: research on motivational interviewing does not automatically establish that a standalone decisional balance worksheet changes substance use. In their paper on motivational interviewing and decisional balance, William Miller and Gary Rose describe these as different ways of responding to ambivalence. They caution that giving equal attention to reasons for and against change can reduce commitment in someone who is undecided. Use this sheet to understand your position, rather than assuming the exercise will make you ready. If you have already chosen a change, focus your next work on carrying it out and addressing obstacles.
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.
Make each entry specific to your own life. Instead of writing only "less stress," name the situation you want relief from and what relief would look like. Separate immediate benefits from consequences that arrive later. Avoid counting entries as votes: a concern about safety may matter more to you than several small conveniences. You can leave uncertainty visible by writing down a question you need answered.
Turn the completed sheet into a conversation or a practical next step. For example, if using helps you feel included socially, consider what support you would need to see friends while changing your substance use. The Drug Addiction Test can offer a separate self-assessment of concerns to discuss with a professional; it cannot diagnose you or decide your plan. You can find professional support through the Psychology.com therapist directory.
A concern about withdrawal belongs in the support plan, even if your reasons for change feel clear. The National Institute on Alcohol Abuse and Alcoholism warns that suddenly stopping alcohol after prolonged heavy drinking can cause potentially life-threatening withdrawal. If this may apply to you, seek medical help before changing your drinking. This worksheet cannot assess withdrawal risk or tell you how to reduce a substance safely; bring that question to a qualified clinician.
When completing this with someone else, ask them to help you understand your own entries rather than supply the answers they want to hear. You might ask, "Which concern do you hear me returning to?" or "What information am I missing?" If a decision is already made, move toward practical planning. The Coping with Cravings Worksheet can help you describe situations that need preparation, and the Addiction Recovery Worksheets collection offers related exercises to discuss with your support team.
References
- Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. Guilford Press; 2013.
- Janis IL, Mann L. Decision Making: A Psychological Analysis of Conflict, Choice, and Commitment. Free Press; 1977.
- Prochaska JO, DiClemente CC. The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Dow Jones-Irwin; 1984.
- 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.
- Miller WR, Rose GS. Motivational interviewing and decisional balance: contrasting responses to client ambivalence. Behavioural and Cognitive Psychotherapy. 2015;43(2):129-141. https://pubmed.ncbi.nlm.nih.gov/24229732/
- National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help
Cite this source
Psychology.com. (2026, September 16). Decisional Balance Worksheet. Psychology.com. https://psychology.com/tools/decisional-balance
Decisional Balance Worksheet FAQ
What is a decisional balance worksheet?
A decisional balance worksheet maps the benefits and costs of staying the same alongside the benefits and costs of changing. It gives mixed feelings a place on the page, including reasons the current behavior feels useful. The completed sheet supports reflection and discussion; it does not diagnose a problem or determine which decision is right for you.
Why list the good things about using?
Naming what using does for you can help you identify a need that your change plan will have to address. For example, if it provides a sense of belonging, your plan may need social support. Write honestly without treating each benefit as a reason you must continue. Bring difficult or conflicting entries to a clinician if you feel stuck.
Will this tell me what to do?
No. There is no total score that selects an answer, and having more entries in a box does not make that option the right choice. Use the sheet to identify the concerns that carry the most weight for you. A useful outcome may be a question to ask a professional, a support need, or a next step you feel willing to consider.
Is my information saved?
No. Everything stays in your browser and nothing is uploaded. The PDF is created on your own device.
How is decisional balance different from a regular pros and cons list?
A regular pros and cons list usually only looks at one option. Decisional balance maps four boxes at once: the pros and cons of staying the same, and the pros and cons of changing. Seeing all four side by side, including the real benefits of the current behavior, gives a more honest and complete picture than a two-column list.
How often should I redo this worksheet?
There is no set schedule. Many people find it helpful to revisit it when their situation shifts, when a craving or setback changes how they see things, or every few weeks during early recovery, since readiness and the weight of each box can change over time. Before repeating the exercise, ask what new information you have. If your choice is settled, work on support and practical barriers instead of reopening the same decision.