Year of Award


Document Type


Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Gyda Swaney

Commitee Members

Bryan Cochran, Christine Fiore, Paul Silverman, David Beck


Alcohol misuse, Medicine Wheel, Native Americans, Substance Misuse, Transtheoretical Model of Change


University of Montana


This qualitative study investigated the constructs of change within the action and maintenance stages of the Transtheoretical Model of Change (TMC) and balance within the domains of the Medicine Wheel (MW). The guiding questions addressed: a) point of focus in sobriety and recovery phases within the domains of the MW, b) specific mechanisms at work, c) support systems, tools, temptations, motivating factors, maintenance, gains, losses, and personal reasons for change, d) spiritual component, e) connection between tribal culture and recovery, and f) distinction between sobriety and recovery.

Eight adult Native Americans in sobriety or recovery for a minimum of 3 years participated. Participants completed a demographic questionnaire and 3 quantitative measurement checks (Native American Acculturation Scale, Garret & Pichette, 2000 revised by Trahan, 2004; Decisional Balance Scale, Maddock, 1997; and the Self-Efficacy Scale, Maddock, 1997). A semi-structured interview format was utilized and interviews were audio-taped. A team of 6 multi-ethnic research assistants transcribed, checked the transcriptions for accuracy, and analyzed the interviews under the guidance of the lead researcher. The participants' responses were analyzed and coded using a Grounded Theory strategy. The scores/findings from the measurement checks were calculated; the majority of participants indicated bicultural behaviors and scored in the expected ranges within the maintenance stage of change.

Both models are applicable with this sample. The MW revealed the process of searching for balance and the TMC showed the process of utilizing the medicine within the MW in order to create change. Strategies that emerged were the utilization of medicine and shifting perspectives. Experiencing a spiritual moment, recollection of the reason one quit drinking alcohol, examination of self and others, and reinforcement were shifts in perspectives that required the utilization of medicine. These led to motivation, balance and new behaviors. A new theoretical model for change and recovery from alcohol misuse emerged; sobriety was described as an event and recovery as a process. When combining the conceptual frameworks of the Medicine Wheel and the TMC, specific mechanisms of change were revealed. The findings may offer clients and therapists a new conceptual framework to facilitate balance and change.



© Copyright 2008 Stacy Miller