Substance abuse does not have a single cause or trigger, but substance use and behavioral problems largely stem from family factors. For example, factors can include parent and sibling substance abuse, parental attitudes that minimize the dangers of drug use, poor relationships with parents, and inadequate childrearing practices (Liddle et al. 2001). The community, social environments, and peer relations also are substantial in the cause of substance use; Family relationship factors and peer relationships were found to be direct mediators of neighborhood and school effects in the progression of adolescent drug problems (Liddle et al. 2001). Family variables are central in the causes and potential solutions for drug problems. Parental monitoring and changes in parenting practices prevent or delay drug involvement, and are related to a decrease in adolescent use even after a pattern has been established (Liddle, et al. 2001). In this study, families consisted of thirty-one percent two-parent households, 48 percent single parent households, and 21 percent stepfamilies. Included in family sessions were the addict, parent(s), other family members, and even extra familial sources of actual or potential influence (Liddle et al. 2001). Ozechowski and Liddle write, "A family systems view of drug abuse focuses on the manner in which the addict's functioning is related to parental, sibling, and extended-family functioning, as well as to patterns of communication and interaction within and between various family subsystems." One study on adolescent health, family relationship variables such as feeling connected to and cared for by one's parents, high parental expectations about school performance, and parents' presence and interest in the adolescent's life all were strong predictors of positive adolescent development. Findings from longitudinal studies demonstrate that problems in family functioning commonly pre-date the initiation of adolescent problem behaviors (Liddle et al. 2001).
Parents can play a major role in a substance use, but siblings of the adolescent at hand often share similar experiences. One researcher found that siblings can be used therapeutically to move an addict to a higher level of functioning. Also, the identified patient can learn behavior from older siblings, especially when they themselves are abusing drugs and alcohol, and can even enable behaviors by purchasing alcohol. This behavior can impact and possible feed the addiction. Although the siblings themselves are not in drug rehab, they are at a greater risk for substance abuse themselves, as well as homelessness and depression relative to others their age. McGue noted that the influence of siblings substance use was not simply a marker for family genetic vulnerability and or parental substance use, but rather appeared to be an independent risk factor.
Siblings of those in drug rehab are impacted by their family conditions, but are generally not in a position to affect changes (Bamberg et al. 2008). The parents hold the capacity to implement change that can affect the identified patient as well as their siblings. In a study done by Bamberg, Toumourou, and Richards, they included siblings in drug rehab and focused on the siblings "giving a voice" to their family experiences. The siblings' role was legitimized through session content aimed to reintegrate and encourage family unity. They were given an opportunity to express their feelings on how their brother or sister's substance use behavior had affected them and equally how, in their opinion, their family had been affected (Bamberg et al. 2008). Siblings also voiced their experiences of good behavior of having been overlooked since the parents had become overly focused on the problems in the family, more specifically the child in distress. They frequently reacted with anger towards their parents since their parents had unfairly allowed the situation at home to escalate. Also, anger was directed towards their brother or sister for distressing and hurting their parents. Parents appeared surprised that family member's behaviors equally affected sibling(s) and that they shared similar feelings on the issue. By the end of the program, the attending siblings had made positive change in 73 percent of the participants as well as gaining their own benefits.