Overcrowding has become one of the nation's principal concerns for local jail systems. Not only does overcrowding contribute to incarceration costs, but it also places a disproportionate strain on law enforcement officials. Between 2000 and 2007 the nation's total jail population increased at an average annual rate of 3.3%, bringing the total number of jail inmates to 780,581.1 Not only has the national average for total jail population experienced a substantial increase, the national prevalence rates for substance dependence in this population have reached exceedingly high numbers as well.

A national survey revealed that more than two-thirds of jail inmates were found to be dependent on alcohol or drugs.2 It appears that substance use disorders are contributing to the increased size of U.S. jail populations as well as having profound effects on recidivism rates.

To address the issue of addictions contributing to recidivism, The Change Companies® developed a 24-page interactive journal titled “Changing Course” designed specifically for individuals struggling with addiction issues in a local correctional setting. (Interactive Journaling® is trademarked, as is the name of The Change Companies.) The focus of this journal is to help individuals make the connection between their substance dependence and criminal activity. This journal is not intended as a treatment tool, but rather to encourage affected individuals to seek treatment upon release.

The journal used in this study, like other Interactive Journaling, is based on principles compatible with motivational enhancement, cognitive-behavioral strategies and the Transtheoretical Model of Change. One of the first steps on the road to change is recognizing and accepting the existing problem. The Changing Course journal encourages inmates to reflect on the choices that have led to their current situation and to recognize alternative, more acceptable ways to lay the foundation for a more rewarding life. In addition, the journal helps the inmate assess the connection between his alcohol and/or drug use and the behaviors resulting in incarceration.

The journal uses a combination of visually appealing images, factual information and simple individual writing exercises to engage the individual as he considers the process of making a positive life change. In addition to reviewing past events, the exercises in the journal guide the inmate through the process of exploring future alternatives and their respective costs and rewards. The journal ends with an outline of a plan for change and a place for the inmate to record contact information for treatment programs in the area and others who might be of help. Treatment information can be obtained from a staff person at the jail.

Testing the concept

Interactive or “reflective” journaling has been shown to be a valuable component of many effective learning strategy methods.3,4,5,6 The vast majority of research on writing and behavioral change has come in the form of brief interventions, which have not been directly connected or integrated with other forms of interventions as is the case with Interactive Journaling as used here. Most studies on journaling were designed to have the participant express in writing life trauma or stressful events, but even these less sophisticated approaches without linkage to behavior change strategies have tended to show positive results on both subjective and objective measures.

Although Interactive Journaling appears to be a useful resource for the promotion of change in various contexts, little attention has been given to the use of this technique in local jail populations. Incarceration in a local jail presents a potential “teaching moment” during which the individual might have an opportunity to take stock of past behaviors and begin to make the connections between behaviors and consequences. However, few jurisdictions have the resources or personnel to provide therapeutic intervention or guidance. Interactive Journaling provides a tool that can begin the change process and guide the inmate to recognize the extent of substance abuse or dependence and the connection to other behaviors—with a minimal investment of time or money on the correctional facility's part.

This report focuses on initial findings from a randomized clinical trial to explore whether the interactive journal Changing Course affects whether inmates who meet diagnostic criteria for substance dependence seek treatment after release and whether the journal has any effect on recidivism rates. In clinical applications, the journal would be part of the overall treatment protocol rather than a stand-alone intervention. This presents a severe test of journaling in that this journal is presented with minimal introduction or supervision—a less than optimal application of Interactive Journaling, but one that is realistic in many jail settings.

With the support of the sheriff, the staff at the Buncombe County Detention Facility in western North Carolina agreed to provide a site for the clinical trial and to participate in the study implementation. The study was approved by the human subjects committee of Western Carolina University.

Inmates at this local county jail are screened using the UNCOPE addictions screen developed for screening recent arrestees7 and subsequently validated on adult state prison inmates8 and juvenile justice populations.9 Two other criteria for admission to the study are that the inmate acknowledges that the current offense was committed while under the influence of drugs or to get drugs, and that jail records indicate that the inmate had been incarcerated at least once before in the previous 12 months.

Those meeting the study criteria are then interviewed by graduate students using the Comprehensive Addictions and Psychological Evaluation (CAAPE), a structured diagnostic interview10 for co-occurring conditions compatible with the DSM-IV-TR.11 The CAAPE is used to verify that individuals meet the diagnostic criteria for substance dependence and to identify any current emotional disorders the inmates might have experienced. Those confirmed as positive for substance dependence are then randomly assigned to receive either a federal booklet on addictions and crime or the interactive journal. In addition, inmates who accept the journal are informed that either the research assistant or the case manager will follow up on their extent of journaling within 72 hours and will answer any questions they might have concerning the journal's content.

Research results

The prerequisite for Interactive Journaling or any other approach to behavior change is that the tool or procedure be accepted and utilized by the individuals whose behavior is to be altered. Thus, the first step in determining potential efficacy of an interactive journal in a local jail population is to explore the extent to which inmates are willing to use a self-directed interactive journal while incarcerated.

Of the 70 inmates offered the Changing Course journal, all but one agreed to take the journal—an acceptance rate of 98.6%. Of the inmates who took the journal, 10 (14.5%) were released before a determination of whether they began the journal could be determined. (Keep in mind that the average duration of incarceration in this local jail is only about 14 days.)

Of the remaining 59 individuals, only 9 (15%) did not engage in the journaling effort, but most of the remaining 85% completed at least some of the writing tasks. Most (56%) completed at least half of the journal before release, and 17% completed the entire journal.

Due to the procedures at the jail, it was not possible to determine the proportion of inmates who took the journal with them at the time of release, but other evaluations of Interactive Journaling used with DUI offenders indicate that many individuals keep their journals.

The present study provides initial evidence that this interactive journal has the potential to engage inmates whose substance dependence contributes to their repeated offending. The interactive journal appears to be well-received by jail inmates, requires minimal investment of staff time, and most importantly is relatively inexpensive.

Perhaps the most important benefit of an interactive journal is the opportunity to gauge an inmate's self-reflective level of change. In the instance of a simple drug and alcohol pamphlet, there is no way of following up or monitoring an inmate's process of change. But with the interactive journal it is possible to determine an inmate's extent of self-awareness, interest and learning based on how much of the journal is completed and the content of the journaling. Engagement is the prerequisite for any further behavior change. The current findings suggest that the Changing Course journal is able to engage the majority of substance-dependent inmates.

This study presents a limitation in that it involves a male and predominantly white sample. Thus, the findings may not generalize to inmates from minority groups or to female populations.

While it is clear that Interactive Journaling is feasible as well as cost-effective due to the findings that inmates have shown a cooperative effort in both accepting and beginning the Changing Course journal at a relatively minor expense, the longer-term outcomes question remains. Does an interactive journal through a brief self-directed approach promote future treatment engagement and reduce criminal recidivism in substance-dependent offenders? This question will be the focus of analyses scheduled to begin once the sample size is larger and after sufficient time has elapsed to determine recidivism rates.