ABSTRACT Objective The present study primarily examines the clinician’s perspective on the initiation of substance use among Pakistani adolescents by using bio-psycho-social correlates. Method Qualitative research design was used to explore the risk and protective factors of substance use. For this purpose, twelve clinical experts i.e., clinical psychologists (N = 6 with HEC-recognized MS Clinical Psychology degree) and psychiatrists (N = 6 with valid PMC) were approached for in-depth interviews. The inclusion of experts with at least five years of experience in dealing with Substance Use Disorders (SUD). Their verbatim was transcribed and thematically analyzed by using NVIVO v.12. Results The findings of this study revealed three main themes for risky behavior i.e., temperamental factors (self-esteem-related problems, anxiety sensitivity, experimentation, and assertiveness issue), family-level factors (parenting style, family conflict, and genetic transmission), and environmental risk factors (peer influence, role of media, and easy access of substance). In addition, the protective factor of substance use also emerged i.e., religiosity or spirituality along with the appropriate parenting which can overcome the risk tendencies of substance use in adolescents. Conclusion The study concluded that appropriate parenting can make a bridge between risk factors of substance use.