Program Profile: Changing Course

This is an interactive journal designed to help incarcerated persons who have been screened or identified as having a potential substance use disorder to help inmates make the connection between their substance use and criminal activity. The program is rated Promising. The recidivism rate of inmates who participated in the program’s interactive journal intervention was statistically significantly lower compared with the control group.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals/Target Population

Changing Course is an interactive journal designed specifically for those incarcerated in a local correctional setting (i.e., jail) who have been screened or identified as having a potential substance use disorder. The primary emphasis of the journal is to help inmates make the connection between their substance use and criminal activity. Changing Course was designed as a self-directed resource for inmates to start the process of making positive life changes. It provides inmates with a way to assess the costs and benefits associated with different life choices they might make and helps them develop a plan for changing their behavior following release.

Program Activities

Changing Course is a 24-page interactive journal that includes visually appealing images, factual information, and individual writing exercises to engage inmates as they contemplate the process of making a positive life change. The journal starts with a checklist of various descriptors that inmates check off if they specifically apply to them. Then inmates must summarize, in their own words, the specific details regarding their arrest and their motivation for committing the offense for which they are currently incarcerated. Next, inmates are provided with an inventory of harmful consequences associated with substance use that cover a wide range of areas, such as relationships, school/work, and finances. Inmates are then presented with another checklist of various behaviors that they may select as they consider making a positive life change (e.g., current level of alcohol or drug use, anger management, relationship changes) and are instructed to indicate which areas apply to them. The journal then provides an outline for evaluating the rewards and costs of up to three specific behavior changes, followed by strategies for inmates to implement the selected changes. Inmates are provided with an area to write down their specific individualized plan for change. Finally, the journal presents inmates with the issue of making the ultimate decision about whether they will seek professional help and/or support groups. This section also provides space where contacts can be written down for future reference.

The journal was not designed for use as a clinical treatment aid. Rather, it is a pretreatment tool to help inmates begin to appreciate the connections between their substance use, behaviors, and problems with the law in order to encourage inmates to seek treatment upon release. Two consequences of using interactive journaling with jail inmates are that stays in local jails are often brief and release can occur abruptly and unexpectedly. Professionals may not get the opportunity to review the inmates’ reactions to the journal, the journaling process, the amount of time spent on the journal, or whether the inmates complete the journaling process at all.

Program Theory

The interactive journaling process includes components of the transtheoretical model of change (Prochaska and Velicer 1997). Through this theoretical model of behavior change, change is viewed as a process involving several stages: precontemplation, contemplation, preparation, action, maintenance, and termination. The transtheoretical model of change provides an integrative framework for how individuals may progress through the various stages of behavior change, and move toward embracing and maintaining a particular behavior. The Changing Course journal encourages inmates to reflect on the choices that have led to their current situation and make acceptable choices of action in the future. The journal is designed to guide inmates from the precontemplation stage to the contemplation, preparation, or action stage of change.

Study

Proctor, Hoffmann, and Allison (2012) examined the effectiveness of the Changing Course interactive journal by conducting a randomized trial among jail inmates booked at the Buncombe County Detention Facility (BCDF) in Asheville, NC, from 2008 to 2009. The facility houses adult pretrial detainees and functions as the county jail for a city and county of moderate size. Only male inmates housed at BCDF participated in the study. A total of 300 male inmates were found eligible for the study based on the following criteria: 1) indications of probable substance dependence; 2) the current offense was substance related; and 3) a previous incarceration within the last 12 months. Eligible inmates were identified during the standard classification process. A brief addictions screen (known as UNCOPE) was integrated into the classification process. Inmates interested in receiving case management services were allocated to either the interactive journaling condition or the control group based on a manual randomized assignment procedure consisting of a coin flip.

Of the 300 eligible inmates, 31 inmates refused their case manager’s offer of assistance, 80 inmates were released before they could be approached, and 4 refused to participate in the study. Of the remaining 185 inmates, 100 were randomly assigned to the interactive journaling condition, and 85 were assigned to the placebo condition. Inmates in the treatment group participated in the interactive journaling process, while inmates in the control group received a government booklet on substance use disorders and criminal behavior.

The sample had an average age of 36.56 years (ages ranged from 18 to 65 years). The race/ethnicity of the sample was 73 percent white, 24 percent African American, and 3 percent Hispanic, Asian, Native American, or other/multiracial ethnicity. Overall, alcohol dependence was the most common substance use disorder (78 percent) followed by cocaine dependence (34 percent), marijuana dependence (20 percent), and heroin dependence (16 percent). There were no statistically significant differences between the groups on any of the demographic or clinical variables.

The primary outcome of interest was the proportion of inmates booked at BCDF within a 12-month follow-up period. Inmates were tracked using the management information system (MIS) of BCDF. The Comprehensive Addiction and Psychological Evaluation (CAAPE) structured diagnostic assessment interview was used to assess for indications of prevalent mental health conditions and substance use disorders.

The relationship between group assignment (interactive journal versus control) and recidivism was analyzed using a chi-square analysis to examine whether the proportion of follow-up incarcerations among the inmates was the same for the two groups.

Information about the Change Course interactive journaling and other criminal justice programs can be found on The Change Companies® Web site.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Prochaska, James O. and Wayne F. Velicer. 1997. “The Transtheoretical Model of Health Behavior Change.” American Journal of Health Promotion 12:38–48.

Proctor, Steven L., Norma G. Hoffman, and Steve Allison. 2009. “Jail Inmates: A Trademarked Journaling Process Shows Promise in Giving Offenders Insight on Their Substance Use.” Addiction Professional 7:22–25.

Proctor, Steven L., Norma G. Hoffman, and Caleb J. Corwin. 2011. “Response Bias in Screening County Jail Inmates for Addictions.” Journal of Drug Issues 41:117–34.