Which of the following are risk factors for developing substance use disorders?

• A. Genetics/family history; early initiation; trauma/ACE
• B. Peer influence; poverty; neighborhood disadvantage; access to healthcare
• C. Co-occurring mental health disorders; genetic predisposition; early initiation; trauma/ACE; poverty
• D. Regular exercise

Answer: (C)

Substance use disorders arise from multiple interacting factors across biological, psychological, and social domains. The best answer reflects that mix by including genetic predisposition, co-occurring mental health disorders, early initiation of use, trauma or adverse childhood experiences, and poverty. Each piece adds to risk in a different way: genetics can make someone more vulnerable to developing dependence; having a mental health disorder often leads to self-medication and shares underlying risk pathways; starting substance use during adolescence disrupts neurodevelopment and increases the chance of problematic use later; trauma and ACEs shape coping strategies and stress reactivity that can drive use; poverty and related social stressors create ongoing stress and barriers to protective resources. Together, these factors capture the broad, real-world picture of what raises the likelihood of developing a substance use disorder.

Options that omit key domains—like not including biological predisposition, trauma, or socioeconomic factors—or that present factors not typically linked as risk factors (such as regular exercise) are less accurate representations of risk for SUDs.