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.