Purpose 🎯

Explore ambivalence about substance use and change without arguing for change.

Weighing Costs and Benefits ⚖️

Invite the patient to examine short-term and long-term benefits and costs of both continued use and change.

Explore:

• What does substance use seem to help with in the short term?
• What does it cost you later?
• What might be difficult about change?
• What might improve if change happens?

Ask the patient what stands out after reviewing the balance.

Supporting Motivation 💡

Use reflective listening and curiosity to help the patient identify personal values, concerns, and possible next steps.

Telehealth / Whiteboard Version 💻

Create a four-box grid: benefits of use, costs of use, benefits of change, and costs of change. Fill it in collaboratively.

Why This Works 🌱

Cost-benefit exploration helps patients clarify ambivalence and identify personally meaningful reasons for change.

Clinical Pearl 🧠

Do not rush the patient toward a conclusion. Let the patient identify what feels most important or surprising.

Documentation Language 📝

Patient participated in a cost-benefit balance activity to explore ambivalence, perceived benefits and costs of substance use, and personal motivation for change.

Clinical Focus: Motivation, Ambivalence, Readiness for Change