TABLE 1.

Drug Use Decisional Balance

Decisional balance
Positives of drug use	Positives of change
Immediate physical pleasure (10)	Feel a greater sense self-discipline (9)
Feeling more “there” (10)	Would be more productive (10)
Feels more emotion (10)	Help him be more comfortable with self (8)
Reduces social anxiety (6)	Greater confidence (6)
Shuts out inner critic voice (7)
People will know “real” self (7)
Mean score = 8.33	Mean score = 8.25
Negatives of drug use	Negatives of change
Feels guilty (7)	Would not enjoy life as much (9)
Others are concerned (6)	Would be ignoring a part of himself (10)
Not as productive (10)	Breaking up with something he loves—a
Feels like it is a crutch (10)	hard breakup (9)
Feels bad (7)
Health problems (7)
Mean score = 7.83	Mean score = 9-33

Note. The Decisional Balance first involves asking the patient to identify the positives and negatives of drug use and the positives and negatives of stopping or changing their use. After these forces are identified, the patient is asked to rate the power of each one, positive or negative, on a scale of 1 to 10. Only those items that achieve a score of 6 or higher are kept. To create a metaphorical calculus of the patient's motivation, means are formulated for each of the four boxes. The force for continued use is the Positives of Drug Use Mean plus the Negatives of Change Mean; the force for recovery or change is the Negatives of Drug Use Mean plus the Positives of Change Mean. In this example, when the ratio of forces is computed, the result is 17.66: 16.08—which helps to illuminate the “stuck” position of this patient.