The Double Bind of Siblings in Adolescent Substance Abuse Treatment

Siblings have been found to be perhaps the greatest source of social risk for adolescent substance abuse, particularly when the relationship is close. But, close sibling relationships are also linked to an array of important developmental and lifelong protective benefits. Sibling closeness simultaneously poses considerable risks and benefits. These conflicting findings suggest opposite treatment directions, or a “double bind” for practice. That sibling closeness risks contagion suggests treatment that aims to decrease sibling closeness. On the other hand, the many lifelong and protective benefits of close sibling relationships suggests increasing sibling closeness when possible. Family-based treatment is recommended for adolescent substance abuse, but offers little explicit direction for involving siblings in general, and none for this double bind. This paper untangles and translates the extant literature into preliminary practice guidelines; the Sibling Substance Abuse Treatment Matrix. Important variations related to gender, and age-spacing are considered. Implications for future research and practice are discussed.