The decisional balance worksheet (DBW), an open-ended measure of motivation to change, may be used to record the perceived advantages and disadvantages of substance use as well as alternative behaviors. Recent findings have indicated that the open-ended DBW can be quantified to validly reflect college students' level of motivation to reduce their drinking (Collins, Carey, & Otto, 2009). The goal of the current study was to enhance our understanding of college students' perceived advantages and disadvantages of drinking by qualitatively examining the content of their decisional balance. Participants were undergraduate college students at a 4-year university (N = 760) who participated in a randomized controlled trial of online brief motivational interventions. Using the DBW, participants recorded the advantages and disadvantages of their current drinking. Conventional content analysis methods were used to extract common themes. Social, enjoyment, and psychological reasons were the most commonly mentioned advantages of drinking, whereas physical side effects, expense and interference with goals were the most commonly mentioned disadvantages of drinking. These findings show that college students primarily use alcohol for enjoyment, particularly in social situations, as well as for coping with stress and social anxiety. On the other hand, many college students report having physical side effects from drinking as well as other kinds of concerns (e.g., expense, calories). Findings suggest that using the open-ended DBW may result in a more client-centered and accurate representation of what college students perceive as advantages and disadvantages to drinking than established, Likert-scale measures of decisional balance.