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One minute you know it’s the right decision and a minute later you feel like you’re overreacting.

Going to rehab: it’s a huge decision, it’s going to disrupt your life and the lives of those close to you in significant ways, it can cost a lot of money and you’re probably not even sure it’s what you need…what do you need?!!

Well, no one else can tell you what’s right for you. You know your body and you know your addiction best, but if you’re having trouble weighing the pros and cons of going to rehab, try this easy exercise to structure your thoughts.

Decisional Balancing

One tool that substance abuse counselors and other mental health professionals use to help their clients make difficult decisions about behavioral change is an exercise called decisional balancing.

Making a decision to change the course of your life is rarely simple, and although one big part of you probably wants treatment, another part of you might wonder if you’re ready, or if you even can achieve lasting change.

  • Ambivalence to change is normal and life is rarely black and white, which is why making major decisions about behavioral change, like about going to rehab to quit drugs or alcohol, can be so hard
  • Structural barriers (like financial difficulties) can further complicate the decision making process

Decisional balancing exercises help you to identify and structure all the shades of grey – both pro and con – that weigh down the balance of any major decision.

And once you’ve identified all the pros and cons of both action and inaction and written them down in an easily comparable arrangement, you’ll have a more structured framework to base a decision upon.

What was an impossible decision sometimes becomes an obvious choice by the end of a decisional balancing exercise.

An Example of a Simple Decisional Balancing Chart

Write out rough table of 4 squares and label the squares with the titles:

  1. Benefits of Going to Rehab
  2. Costs of Going to Rehab
  3. Benefits of Not Going to Rehab
  4. Costs of Not Going to Rehab

And under each title, brainstorm for examples of likely costs/benefits. For example:

Benefits of Going to Rehab Costs of Going to Rehab
  • Will be able to detox safely and feel healthier right away
  • Will have a period away from temptation to get clean and sober and get my head sorted out a bit
  • Will have a period of time to focus exclusively on my recovery
  • Will learn relapse prevention and other skills that will help me stay sober after rehab
  • Will have some time to get physically and mentally healthy again
  • Once I am sober I won’t be getting DUIs or be getting in trouble at work or with my spouse anymore
  • Hard to find enough money to pay for it
  • Will have to take a leave of absence from work – could have consequences
  • Rehab might not be right for me and I might find it stupid or not helpful
  • Will have to tell friends/family where I am going – could be embarrassing
  • Will have to arrange for someone to take care of my dog and apartment while I am away
  • It might not work and will have gone through all this trouble for nothing
  • Won’t be able to go out with friends and have fun anymore after I go to rehab


Benefits of Not Going to Rehab Costs of Not Going to Rehab
  • Can still go out and get wasted and have fun
  • Will save a lot of money
  • Won’t have to answer uncomfortable questions about where I am going
  • Won’t have to try to get a month off at work
  • The pains I am having in my stomach will probably keep getting worse
  • Probably will die much younger if I don’t get sober soon
  • Might lose my job from showing up hung-over all the time
  • I will probably get more DUIs and might end up in jail


Ready to Try a Decisional Balancing Exercise for Yourself?

So are you grappling with a decision about rehab or addiction treatment – or about any type of major behavioral change? If so, why not sit down with a pencil and paper and take 10 minutes to write out the pros and cons of both sides of your dilemma.

If it doesn’t clarify things then you’ve wasted nothing more than a few minutes of your time, but you’ll likely find it easier to choose a course of action once you’ve structured things to enable a side by side comparison of the costs and benefits of both action and inaction.

And if it does work and it does transform ambivalence and indecision into motivation for action, then it is 10 minutes very well spent indeed.1

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Page last updated Jul 02, 2021

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