The prevalence and risk factors of suicidal behavior among people who use drugs and alcohol: A comprehensive systematic review

There are various studies which investigated the prevalence and risk of suicide among people who use substance. However, there is lack of a systematic review to intensively summarize and analyze the findings of these studies in order to deduce important clinical implications. Hence, this systematic review aimed to explore the prevalence, risk and protective factors of suicidal behavior among people who use drugs and alcohol. A comprehensive search for research articles from 1980 to 2025 was carried out through major databases, data extraction and assessment of quality of the selected research articles were performed by two authors. A total of 26 articles were selected for review. The prevalence of suicidal ideation among substance and alcohol users ranged from 9.9 to 50.7%, while the prevalence of suicidal attempt ranged from 2.7 to 47%. The common risk factors of suicidal behavior among people who use drugs and alcohol were history of dysphoric-mixed or depressive disorders, younger age (<30 years old or 30-39 years), increase number of drug use, polydrug use or concurrent use of more than one substance, history of personality disorders or traits, history of previous or repeated suicidal attempts, and female gender. Those with risk factors of suicidal behavior must be thoroughly monitored, and effective psychosocial intervention for managing the modifiable risk factors must be implemented.