Van Horn, D. H.A., & Bux, D.A. (2001). A pilot test of motivational interviewing groups for dually diagnosed inpatients. Journal of Substance Abuse Treatment, 20, 191-195.

MI Group 4: Decisional Balance

Rationale: Note – this is essentially the same as the rationale for group 1. The wording may be varied but the main points are as follows.

Most people here in the hospital realize they may have a problem with drinking or drug use, and that they may need to stop using. At the same time, though, alcohol and drugs have a very important place in people’s lives, and people are used to having them around. People often have an especially hard time avoiding using when they are faced with a situation that reminds them of the things they liked about drugs and alcohol, or when they find themselves missing certain things about their drug-using lifestyle. At times like this many people in the early stages of recovery might not be 100% sure they can or even want to give up using altogether. We have found that it is often helpful to bring some of those things out into the open, so you can take a good look at the things that might tempt you back into using, as well as the reasons for getting or staying clean. Often this helps people deal better with cravings or temptations to use.

Exercise: Leader draws decisional matrix diagram on the board (ideally, this is done before the patients enter the room), including short- and long-term positive and negative consequences of alcohol/drug use and abstinence. Positive and negative consequences may be called “good things” and “not so good things.”

Leader elicits in following order – good (short/long term), not-so-good (short/long term) of alcohol/drug use; good (short/long term), not-so-good (short/long term) of abstinence. Write down patients’ responses in appropriate places in the diagram.

Discussion – note contrast between short-term good vs. long-term bad of alcohol/drug use; short-term bad (if noted) vs. long-term good of abstinence. Note that “not-so-good” aspects of abstinence are a challenge and elicit group ideas for managing these challenges.

Notes: Discussion of the positive effects of drug use may engender resistance from patients who argue that there are no positive effects of drug use. Encourage them to hold their thoughts until you reach the negative aspects of drug use so as to allow other patients the freedom to discuss the full range of their experience of drug use and abstinence.

More than the other exercises in this sequence, this one tends to help patients explore broader aspects of the drug-using vs. abstinent lifestyle and discover more of the challenges of abstinence.