International Journal of Mental Health and Addiction

, Volume 17, Issue 6, pp 1580–1598 | Cite as

Systematic Review of Suicidal Behaviour in Individuals Who Have Attended Substance Abuse Treatment

  • Helena RontziokosEmail author
  • Frank Deane
Original Article


Worldwide, more than 1 million people take their life every year. In Australia, 3027 deaths by suicide were reported in 2015, the highest rate reported in 10 years. There is an alarming disparity between suicide rates across Indigenous and non-Indigenous people documented in many countries around the world. Between 2001 and 2010, the overall suicide rate for Indigenous Australians was twice that for non-Indigenous individuals. Compared to the general population, those with substance abuse disorders are almost 10 times more likely to die from suicide. In alcohol and other drug treatment (AOD) services, one in seven (15%) clients are Indigenous, despite representing only 3% of the entire Australian population. In order to better understand the current status of research in the field, a systematic review was completed aimed at identifying studies that reported the prevalence of suicidal behaviour in substance abuse treatment settings, with the additional aim of comparing rates and risk profiles across Indigenous and non-Indigenous Australians. We identified 20 studies reporting rates of suicidal behaviour in individuals who have attended AOD treatment. Rates of suicidal ideation, suicide attempts and death by suicide were reported across multiple studies. Eleven studies reported rates of lifetime suicide attempts with prevalence rates ranging from 17.1 to 47% (median = 30.2%; mean = 29.2%). No studies were identified reporting Australian Indigenous rates of suicidal behaviour in substance abuse treatment settings, highlighting a significant gap in the literature.


Prevalence Suicide Suicidal behaviour Substance abuse Treatment Indigenous 


Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest or ethical concerns regarding the research paper.


  1. Atkinson, J. (2002). Trauma trails, recreating song lines: the transgenerational effects of trauma in Indigenous Australia. North Geelong: Spinifex Press.Google Scholar
  2. Australian Bureau of Statistics (2008). National Survey of Mental Health and Wellbeing: summary of results, 2007 (cat. no. 4326.0). Retrieved from
  3. Australian Bureau of Statistics (2012). Suicides, Australia, 2010 (cat. no. 3309.0). Retrieved from
  4. Australian Bureau of Statistics (2013). Estimates of Aboriginal and Torres Strait Islander Australians, June 2011 (cat. no. 3238.0.55.001). Retrieved from
  5. Australian Bureau of Statistics (2014). Causes of death, Australia, 2014 (cat. no. 3303.0). Retrieved from
  6. Australian Bureau of Statistics (2016). Causes of death, Australia, 2015 (cat. no. 3303.0). Retrieved from
  7. Australian Department of Health and Ageing. (2013). National Aboriginal and Torres Strait Islander suicide prevention strategy. Canberra: Commonwealth of Australia Retrieved from:$File/Indigenous%20Strategy.pdf.Google Scholar
  8. Australian Institute of Health and Wellbeing (2011). Substance use among Aboriginal and Torres Strait Islander people. Retrieved from
  9. Australian Institute of Health and Wellbeing (2013). Illicit use of drugs. Retrieved from
  10. Australian Institute of Health and Wellbeing (2015). Alcohol and other drug treatment services (AODTS) Retrieved from
  11. Bakken, K., & Vaglum, P. (2007). Predictors of suicide attempters in substance-dependent patients: a six-year prospective follow-up. Clinical Practice and Epidemiology in Mental Health, 3, 20. Scholar
  12. Berry, S., Crowe, T. P., & Deane, F. P. (2012). Preliminary development and content validity of a measure of Australian Aboriginal cultural engagement. Ethnicity and Health, 17, 325–336. Scholar
  13. Beynon, C. M., & McVeigh, J. (2007). The role of substance use in non-drug related deaths: a cross-sectional study of drug treatment clients in the north west of England. Journal of Substance Use, 12(1), 39–47. Scholar
  14. Bohnert, A. S. B., Roeder, K. M., & Ilgen, M. A. (2011). Suicide attempts and overdoses among adults entering addictions treatment: comparing correlates in a U.S. national study. Drug and Alcohol Dependence, 119(1–2), 106–112. Scholar
  15. Broome, R. (2010). Aboriginal Australians. A history since 1788. Crows Nest: Allen & Unwin.Google Scholar
  16. Brown, R. (2001). Australian Indigenous mental health. Australian and New Zealand Journal of Mental Health Nursing, 10(1), 33–41. Scholar
  17. Chang, S. S., Stuckler, D., Yip, P., & Gunnell, D. (2013). Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. British Medical Journal, 347, f5239.CrossRefGoogle Scholar
  18. Clifford, A. C., Doran, C. M., & Tsey, K. (2013). A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand. BMC Public Health, 13(1), 1. Scholar
  19. Conner, K. R., Britton, P. C., Sworts, L. M., & Joiner, T. E. (2007). Suicide attempts among individuals with opiate dependence: the critical role of belonging. Addictive Behaviors, 32, 1395–1404. Scholar
  20. Conrad, K. J., Bezruczko, N., Chan, Y. F., Riley, B., Diamond, G., & Dennis, M. L. (2010). Screening for atypical suicide risk with person fit statistics among people presenting to alcohol and other drug treatment. Drug and Alcohol Dependence, 106(2–3), 92–100. Scholar
  21. Darvishi, N., Farhadi, M., Haghtalab, T., & Poorolajal, J. (2015). Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS One, 10(5), e0126870.CrossRefGoogle Scholar
  22. Demirbas, H., Celik, S., Ilhan, I. O., & Dogan, Y. B. (2003). An examination of suicide probability in alcoholic in-patients. Alcohol and Alcoholism, 38(1), 67–70. Scholar
  23. Dudley, M. (2004). Addressing indigenous suicide: a special case? A response to Colin Tatz. Australian Aboriginal Studies, 2, 26 Retrieved from;dn=449426673960949;res=IELAPA.Google Scholar
  24. Dukes, P., Robinson, G., & Robinson, B. (1992). Mortality of intravenous drug users: attenders of Wellington Drug Clinic, 1972-89. Drug and Alcohol Review, 11(2), 197–201. Scholar
  25. Eckermann, A.-K., Dowd, T., Chong, E., Nixon, L., & Gray, R. (2010). Binan Goonj: bridging cultures in Aboriginal health. Chatswood: Elsevier Australia.Google Scholar
  26. Elliott-Farrelly, T. (2004). Australian Aboriginal suicide: the need for an aboriginal suicidology? Australian e-Journal for the Advancement of Mental Health, 3(3), 138–145 Retrieved from: Scholar
  27. Engström, A., Adamsson, C., Allebeck, P., & Rydberg, U. (1991). Mortality in patients with substance abuse: a follow-up in Stockholm County, 1973–1984. International Journal of the Addictions, 26(1), 91–106. Scholar
  28. Fudalej, S., Ilgen, M., Kolodziejczyk, I., Podgorska, A., Serafin, P., Barry, K., … Bohnert, A. (2015). Somatic comorbidity and other factors related to suicide attempt among polish methadone maintenance patients. Journal of Addiction Medicine, 9(6), 433–439. doi: Scholar
  29. Glass, J. E., Ilgen, M. A., Winters, J. J., Murray, R. L., Perron, B. E., & Chermack, S. T. (2010). Inpatient hospitalization in addiction treatment for patients with a history of suicide attempt: a case of support for treatment performance measures. Journal of Psychoactive Drugs, 42(3), 315–325. Scholar
  30. Gomberg, E. S. L. (1989). Suicide risk among women with alcohol problems. American Journal of Public Health, 79(10), 1363–1365. Scholar
  31. Hakansson, A., Bradvik, L., Schlyter, F., & Berglund, M. (2010). Factors associated with the history of attempted suicide. Crisis, 31, 12–21. Scholar
  32. Hanssens, L. (2007). Indigenous dreaming: how suicide in the context of substance abuse has impacted on and shattered the dreams and reality of Indigenous communities in Northern Territory, Australia. Aboriginal and Islander Health Worker Journal, 31(6), 26 Retrieved from;dn=957286938108787;res=IELHEA.Google Scholar
  33. Hasin, D., Grant, B., & Endicott, J. (1988). Treated and untreated suicide attempts in substance abuse patients. Journal of Nervous and Mental Disease, 176(5), 289–294 Retrieved from Scholar
  34. Hser, Y. I., Kagihara, J., Huang, D., Evans, E., & Messina, N. (2012). Mortality among substance-using mothers in California: a 10-year prospective study. Addiction, 107(1), 215–222. Scholar
  35. Hunter, E., & Milroy, H. (2006). Aboriginal and Torres Strait Islander suicide in context. Archives in Suicide Research, 10(2), 141–157.CrossRefGoogle Scholar
  36. Ilgen, M. A., Tiet, Q., & Moos, R. (2004). Outcomes of substance use disorder treatment in suicidal and nonsuicidal male patients. Journal of Studies on Alcohol, 65(5), 643–650.CrossRefGoogle Scholar
  37. Ilgen, M. A., Tiet, Q., Finney, J. W., & Harris, A. H. (2005). Recent suicide attempt and the effectiveness of inpatient and outpatient substance use disorder treatment. Alcoholism: Clinical and Experimental Research, 29(9), 1664–1671. Scholar
  38. Ilgen, M. A., Harris, A. H. S., Moos, R. H., & Tiet, Q. Q. (2007). Predictors of a suicide attempt one year after entry into substance use disorder treatment. Alcoholism: Clinical and Experimental Research, 31(4), 635–642. Scholar
  39. Ilgen, M. A., Burnette, M. L., Conner, K. R., Czyz, E., Murray, R., & Chermack, S. (2010). The association between violence and lifetime suicidal thoughts and behaviors in individuals treated for substance use disorders. Addictive Behaviors, 35(2), 111–115. Scholar
  40. Joiner, T. (2005). Why people die by suicide. Cambridge: Harvard University Press.Google Scholar
  41. Kennedy, M. C., Marshall, B. D., Hayashi, K., Nguyen, P., Wood, E., & Kerr, T. (2015). Heavy alcohol use and suicidal behavior among people who use illicit drugs: a cohort study. Drug and Alcohol Dependence, 151, 272–277 Scholar
  42. Kirst, M., Aery, A., Matheson, F. I., & Stergiopoulos, V. (2017). Provider and consumer perceptions of trauma informed practices and services for substance use and mental Health Problems. International Journal of Mental Health and Addictions, 15, 514–528. Scholar
  43. Kropp, F., Somoza, E., Lilleskov, M., Moccasin, M. G. B., Moore, M., Lewis, D., … Winhusen, T. (2013). Characteristics of northern plains American Indians seeking substance abuse treatment in an urban, non-tribal clinic: a descriptive study. Community Mental Health Journal, 49(6), 714–721. doi: Scholar
  44. McHugh, C., Campbell, A., Chapman, M., & Balaratnasingam, S. (2016). Increasing indigenous self-harm and suicide in the Kimberley: an audit of the 2005-2014 data. Medical Journal of Australia, 205(1), 33–33. Scholar
  45. McLellan, A. T., Luborsky, L., Woody, G. E., & O’Brian, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index. The Journal of Nervous and Mental Disease, 168(1), 26–33 Retrieved from Scholar
  46. McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9(3), 199–213. Scholar
  47. Merrall, E. L. C., Bird, S. M., & Hutchinson, S. J. (2012). Mortality of those who attended drug services in Scotland 1996-2006: record-linkage study. International Journal of Drug Policy, 23(1), 24–32. Scholar
  48. Ortiz-Gomez, L. D., Lopez-Canul, B., & Arankowsky-Sandoval, G. (2014). Factors associated with depression and suicide attempts in patients undergoing rehabilitation for substance abuse. Journal of Affective Disorders, 169, 10–14. Scholar
  49. Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis. Journal of Public Health, 38(3), e282–e291.CrossRefGoogle Scholar
  50. Preuss, U. W., Schuckit, M. A., Smith, T. L., Danko, G. P., Bucholz, K. K., Hesselbrock, M. N., Hesselbrock, V., & Kramer, J. R. (2003). Predictors and correlates of suicide attempts over 5 years in 1,237 alcohol-dependent men and women. American Journal of Psychiatry, 160(1), 56–63. Scholar
  51. Procter, N. G. (2005). Parasuicide, self-harm and suicide in aboriginal people in rural Australia: a review of the literature with implications for mental health nursing practice. International Journal of Nursing Practice, 11(5), 237–241. Scholar
  52. Ravndal, E., & Vaglum, P. (1999). Overdoses and suicide attempts: different relations to psychopathology and substance abuse? A 5-year prospective study of drug abusers. European Addiction Research, 5(2), 63–70. Scholar
  53. Ridani, R., Shand, F. L., Christensen, H., McKay, K., Tighe, J., Burns, J., & Hunter, E. (2015). Suicide prevention in Australian Aboriginal communities: A review of past and present programs. Suicide and Life-threatening Behavior, 45(1), 111–140. Scholar
  54. Ross, J., Teesson, M., Darke, S., Lynskey, M., Ali, R., Ritter, A., & Cooke, R. (2005). The characteristics of heroin users entering treatment: findings from the Australian Treatment Outcome Study (ATOS). Drug and Alcohol Review, 24(5), 411–418. Scholar
  55. Ross, J., Darke, S., Kelly, E., & Heatherington, K. (2012). Suicide risk assessment practices: a national survey of generalist drug and alcohol residential rehabilitation services. Drug and Alcohol Review, 31, 790–796. Scholar
  56. Silburn, S., Robinson, G., Leckning, B., Henry, D., Cox, A., & Kickett, D. (2014). Preventing suicide among Aboriginal Australians. In P. Dudgeon, H. Milroy, & R. Walker (Eds.), Working together: Aboriginal and Torres Strait islander mental health and wellbeing principles and practice (2 ndedition) (pp. 147–164). Canberra: Commonwealth of Australia.Google Scholar
  57. Sveticic, J., Milner, A., & De Leo, D. (2012). Contacts with mental health services before suicide: a comparison of Indigenous with non-Indigenous Australians. General hospital psychiatry, 34(2), 185–191.Google Scholar
  58. Tatz, C. (1999). Aboriginal suicide is different: Aboriginal youth suicide in New South Wales, the Australian Capital Territory and New Zealand: towards a model of explanation and alleviation. Criminology Research Council grant. Google Scholar
  59. Tatz, C. (2005). Aboriginal suicide is different: a portrait of life and self-destruction. Aboriginal Suicide is different: a portrait of life and self-destruction, xxv.Google Scholar
  60. Tiet, Q. Q., Ilgen, M. A., Byrnes, H. F., & Moos, R. H. (2006). Suicide attempts among substance use disorder patients: an initial step toward a decision tree for suicide management. Alcoholism: Clinical and Experimental Research, 30(6), 998–1005. Scholar
  61. Trewin, D. (2004). National Aboriginal and Torres Strait Islander health survey: Australia.$File/47150_2004-05.pdf. Accessed 23 Nov 2018.
  62. Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. Scholar
  63. Värnik, P. (2012). Suicide in the world. International Journal of Environmental Research and Public Health., 9(3), 760–771.CrossRefGoogle Scholar
  64. Wilcox, H. C., Conner, K. R., & Caine, E. D. (2004). Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug and Alcohol Dependence, 76, S11–S19. Scholar
  65. Wilke, D. J. (2004). Predicting suicide ideation for substance users: the role of self-esteem, abstinence, and attendance at 12-step meetings. Addiction Research and Theory, 12(3), 231–240. Scholar
  66. World Health Organisation (WHO) (2014). Preventing suicide: a global imperative. Retrieved from /world_report_2014/en/.
  67. You, S., Van Orden, K. A., & Conner, K. R. (2011). Social connections and suicidal thoughts and behavior. Psychology of Addictive Behaviors, 25(1), 180–184.CrossRefGoogle Scholar
  68. Yuodelis-Flores, C., & Ries, R. K. (2015). Addiction and suicide: a review. The American Journal on Addictions, 24(2), 98–104. Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of WollongongWollongongAustralia

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