Psychoactive substance abuse and psychoactive substance dependence among adolescents are considered to be high-risk factors for attempted and completed suicide. The typical adolescent at risk for suicide in the United States is a Caucasian male who is likely to be intoxicated and is likely to commit suicide with a firearm without ever seeking treatment. Psychopathologies such as depression and conduct disorder and personality disorders accompanied by precipitating events are frequently present. This review will examine the association between substance abuse and/or substance dependence and suicidal behavior from an epidemiological perspective. Clinical implications and research directions will be offered in conclusion.