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.