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Trauma exposure—especially chronic or early-life—elevates risk for SUD through multiple pathways: dysregulation of the HPA axis and stress systems, heightened negative affect, and reliance on substances for short-term relief (negative reinforcement). This bidirectional relationship also means SUD can increase trauma exposure risk (e.g., unsafe environments), but the primary mechanism for increased prevalence is not pharmacology alone (Option C). Co-occurrence is common, not rare (Option A). Contemporary, evidence-informed care supports integrated or concurrent treatment; delaying trauma-focused therapy for a fixed abstinence period (Option D) is not universally required and may prolong suffering. Instead, clinicians assess stability, safety, and readiness, employing stage-appropriate options like Seeking Safety, trauma-informed CBT, or skills-based preparatory work. Recognizing the trauma-SUD nexus helps tailor interventions (grounding skills, distress tolerance, craving management) and coordinate care with mental health providers, thereby reducing relapse risk and improving outcomes.