Module 9: working with young people on AOD issues: learner's workbook

5.2 Good things/less good things

Page last updated: 2004

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.
Resistance is minimised when you start with the positive things about a young person's substance use and then talk about the 'less good things', rather than start with 'problems' or 'concerns'. This allows the young person to identify areas of concern without feeling that these are being labelled as a big problem. It also assists the young person to develop some perspective on their situation. It can be useful to write down the good things/less good things so that a visual picture of the situation develops.

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. Terms such as 'problem' or 'concern' are often best avoided. Rather, the aim of the strategy is to explore young people's feelings about their substance use. They, rather than you, identify potential problem areas.

The wording of your questions exploring the pros and cons or good and less good things about using is critical at this point. Poorly-phrased questions or statements can lead to increased resistance in a young person.

Good things and less good things about drug use
Reflection
Good things/less good things (decisional-balancing)
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Good things and less good things about drug use

Task

A 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:

Question - 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' template

For 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.

Reflection

Task

Question - In terms of the Stages-of-Change model, in which stage/s do you think this tool might be appropriately used with a young person? Why?

Answer - (Write your answer, then check the possible answers page.)

Question - In terms of the ten-point change scale, at which end of the spectrum do you think this strategy might work best?

Answer - (Write your answer, then check the possible answers page.)

Workplace learning activity

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?Top of page

Good things/less good things (decisional-balancing)

Task

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.