Looks at how specific patterns of substance use may increase suicide risk. Highlights intersecting factors, such as the type of substance and the amount consumed, as well as biological and social influences. Notes that some groups, such as men and older adults, may be at a higher risk due to overlapping health and social inequities, including trauma, co-occurring disorders, stigma and difficulty accessing health care. Offers prevention and intervention approaches that could improve services and support, and suggests areas for further research.

Key findings:

• Substance use and SUD appear to be associated with an increased risk of suicide.
• The relationship among substance use, SUD and suicide is complex and affected by many intersecting factors. Trauma, health and social inequities, stigma, co-occurring disorders and stressful life events contribute to suicide risk among people with substance use concerns or SUDs.
• Some groups might be at higher risk of suicide because of overlapping health and social inequities. Intersections of race, ethnicity, sex, gender, poverty, and biological and cultural factors might increase the risk of suicidal thoughts, suicide attempts and death by suicide in people with substance use concerns or SUDs. 
• To gain a full picture of suicide risk among people with substance use concerns or SUDs, research must consider the impacts of stigma and structural and systemic factors that can affect access to care and lead to under reporting. 
• Suicide risk appears to increase during treatment for SUD and in the 12 months after.
• Health and social service providers should conduct ongoing assessment for suicide risk at regular intervals over the short and long term to be able to identify concerns and respond early.
• Aftercare and long-term supports are essential to help reduce the risk of recurrence and provide ongoing supports.
• Screening tools for people with substance use concerns who are at risk for suicide should be evaluated to ensure they are effective and meaningful.