This strategy, known as decisional-balancing (Saunders and Wilkinson, 1990) represents the 'heart and soul' of motivational interviewing. It is an essential strategy for building and exploring ambivalence about current drug use and the possibility of changing drug use.
An exploration of the two sides of the young person's substance use serves a number of purposes. The strategy:
- helps to build rapport
- helps assess how the young person feels
- assesses readiness for change
- assesses other dimensions (e.g. triggers for relapse if change were to occur)
- when the good things and less good things are written down it provides a visual representation of the situation.
Begin by expressing empathy for the young person's position. Try to elicit from the young person the benefits and costs of their alcohol or drug use. This strategy is a useful way of assessing the stage of change and the degree of ambivalence.
Be careful not to presume that the costs or 'less good things' related to substance use are a source of great concern to the young person.
Good things and less good things about drug use
Optional exercise – Self reflection
Good things/less good things (Decisional-balancing)
Good things and less good things about drug useA useful tool for recording the information gathered during a discussion of the good things and less good things about staying the same or changing (decisional-balancing) is shown below:
Top of pageQuestion - Using smoking marijuana as an example, answer the following questions, by using the tool 2 template below.
- What might be some of the positives of smoking marijuana?
- What might be some of the negatives associated with smoking marijuana?
- What might be some of the positives of not smoking marijuana?
- What might be some of the negatives associated with changing marijuana smoking?
Tool 2: 'Good things/less good things' templateFor the following two cases, list the 'good things' and the 'not so good things':
- Continue drug use
- Reduce/stop drug use
Hint: Consider effect on finance, friendships, relationships, health, work, legal issues etc.
Optional exercise – Self reflection
Task - workplace learning activity/writing exerciseAsk learners to revisit their own 'habit' they discussed earlier in Topic 4.
Once again in pairs ask learners to draw up a 'decisional-balance sheet' and consider the good things and less good things about their 'habit'. Learners should take this in turn and discuss their responses.
Depending on the group, they could discuss this together.
Brainstorm exerciseQuestion - In terms of the Stages-of-Change model, which stage/s do you think this tool might be appropriately used with a young person? Why?
Answer - This tool may be useful at the beginning of conversation with a young person as it can assist in developing rapport and avoids discussing drug use as a 'problem'. The good/less good things strategy can also be used when young people are thinking more about change (in the contemplative/action phases). You may ask the young person to describe the good things about their current (or past) efforts to change and some of the less good things. Remember the goal is always to facilitate or lead movement to the next stage of change without forcing the young person.
Question - In terms of the ten-point change scale, at which end of the spectrum do you think this strategy might work best?
Answer - This strategy is probably most useful in the lower half of the scale where people are either not considering, are beginning to consider or have tried to make small changes (0-5).
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Task - workplace learning activity/writing exerciseAsk learners to complete the following questions in class or as a take away exercise. Refer them to their Learner's Workbook.
Question - In your own work with young people, outline some situations in which this tool might be useful.
Question - What might be some barriers to using this tool with the young people you work with or in your workplace?
Question - What are some strategies that might assist you in overcoming those barriers?
Optional exercise – Short essayAsk learners to write a short 400-600 word essay that considers each of the three questions outlined above. Learners are encouraged to reflect on their own workplace experiences and workplace practice.
Good things/less good things (Decisional-balancing)Spend some time with a young person and ask for the following information.
Question - 'What are/were some of the good things about your use of alcohol/drugs?'
Question - 'What are/were some of the not-so-good things about your use of alcohol/drug(s)?'
Question - 'What are some of the good things about making a change to your drinking/drug use?'
Question - 'What are some of the not-so-good things about making a change to your drinking/drug use?'
Discuss with the young person what it is like to have the opportunity to discuss the positives and negatives of using substances and changing substance use.