Self-Esteem and Substance Use Disorders

Self-esteem is the fundamental way you feel about yourself. It stems from the conscious and subconscious beliefs you have about yourself and the world, which are often shaped early in life. Self-esteem plays an important role in your level of happiness and quality of life.

According to Abraham Maslow’s hierarchy of needs, self-esteem is one of the most basic human motivations. Maslow believed that people need inner self-respect in order to experience personal growth and achieve self-actualization, which is the fulfillment of one’s talents and potential. Self-esteem is largely rooted in childhood, based on our relationships with peers, parents, teachers, coaches, and religious authorities. It evolves throughout life, shaped by past and present experiences, our relationships, and how we perceive the world.

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People with high self-esteem are more likely to be happy than those who have low self-esteem. If you have high self-esteem, you probably:
•Don’t compare yourself to others
•Are not a bully
•Don’t let a single negative event ruin your day
•Don’t dwell on your failures
•Are kind to yourself in thought and deed
•Don’t try too hard to please others
•Strive to be open and honest
•Are a leader
•Don’t fish for compliments
•Aren’t afraid to take risks


Low self-esteem can impact all areas of your life, from your relationships to your job satisfaction. It can also lead to substance abuse, which may lead to a substance use disorder.



Low self-esteem isn’t always easy to recognize, even in yourself. It can show up in a number of ways, including perfectionism, procrastination, and a mean competitive streak. It can result in constant anger about feeling like you aren’t good enough, or it can show up as depression or anxiety. It can leave you chronically unassertive and co-dependent, always underachieving and waiting for someone else to come to the rescue.

According to the commonly used Rosenberg Self-Esteem Scale, signs you may have low self-esteem include believing that:1

•Others are better than you
•You have no or few good qualities
•You are a failure
•Other people can do things better than you
•You don’t have much to be proud of

If you have low self-esteem, you may believe that you’re not important, or you may expect other people to humiliate you. You may have trouble trusting others, feel lonely and separated from others, or be constantly influenced by your own negative thoughts and feelings. You may need constant external positive reinforcement in order to overcome negative thoughts about yourself.

The negative attitude of people with low self-esteem typically shows up as negative self-talk. Your inner voice has a major impact on how you feel about yourself, and when it belittles your accomplishments, criticizes your mistakes, and uses words like “worthless” or “stupid” to describe you, it’s extremely difficult to feel anything but self-loathing.


Low self-esteem often originates from childhood or adolescence, when you first develop your opinion about yourself. The most common sources of low self-esteem include:

Disapproval From Authority Figures
People who grow up hearing from parents, teachers, or other authority figures that they’re not good enough often have low self-esteem as adults. Hearing negative, unsupportive criticism growing up makes it hard to feel confident later on. Disapproving authority figures can instill shame, guilt, and a sense of failure in a young person, and these are very hard to shake.
Uninvolved Caregivers
Caregivers who don’t seem to care leave children feeling like their achievements aren’t worth noticing. Children with uninvolved parents feel unacknowledged, forgotten, and unimportant. They may grow up feeling as though they should apologize for their existence.
Conflict in the Home
Growing up with conflict at home can negatively impact self-esteem. Fighting between parents or other caregivers creates negative emotions like fear and anxiety in children, who often feel responsible for the unrest.
Adults who were bullied as children or adolescents may have problems with self-esteem later on, especially if they had no support at home while the bullying was taking place. They can feel hopeless, abandoned, and filled with self-loathing. Later on, this can lead to the belief that anyone who befriends you is doing you a favor. It can also lead to a deep distrust of others.
Academic Challenges
Poor academic performance can lead to low self-esteem in a few ways. It can make young people feel unworthy, especially if teachers and caregivers criticize or place undue emphasis on their poor performance. Children with learning disabilities have been shown to have a high prevalence of low self-esteem that stems from lower rates of peer acceptance and fewer positive interactions with teachers, according to a study published in the journal Social Psychology of Education.2 If young people are made to feel stupid and defective in school, they’ll often grow up to feel stupid and defective as adults.
Experiencing physical, sexual, or emotional abuse as a child or adult has a profound impact on self-esteem. Abuse makes it difficult to trust others, and abusers often make the victim out to be at fault for the abuse. People who have a history of trauma often have very low self-esteem and dysfunctional coping mechanisms, including substance abuse.
People who had a very religious upbringing often have low self-esteem stemming from growing up being told and believing that they are perpetual sinners unworthy of salvation. Shame and guilt often result from these beliefs, and the resulting deep inner conflict and self-loathing may follow people into adulthood.
Cultural Influences
Growing up in a culture that denigrates or sexualizes women or demands that men always be strong can impact self-esteem in childhood and beyond. Additionally, those who don’t live up to societal expectations, especially expectations portrayed in the media, may feel lacking, inadequate, and unworthy.

Studies show that self-esteem tends to increase from adolescence to middle age before decreasing after the age of 60.

Body Type
People who are overweight or obese are particularly at risk for low self-esteem or other self-esteem issues.
Women are more likely to report feelings of low-self esteem than men. However, it is possible that is due to women feeling more comfortable sharing how they feel compared to men.
Sexual Identity
People who are LGBTQ are more likely to struggle with self-esteem over their straight peers, partly due to bullying or disapproval from their parents or religious communities.
Socioeconomic Status
People who experience discrimination or systemic disadvantages due to low income may experience lower self-esteem than those from a higher socioeconomic status.

Effects of Low Self-Esteem on Your Life

Low self-esteem can have devastating consequences in your life. Some of the negative impacts of low self-esteem include:

Mental Illness
Low self-esteem can lead to anxiety or depressive disorders. It can also contribute to eating disorders like anorexia nervosa, bulimia nervosa, or binge eating disorder.

Lack of Self-Care
When feelings of futility come from low self-esteem, it can lead to a “why bother?” attitude regarding self-care. A lack of self-care may show up as substance abuse or disordered eating.

Feelings that often accompany low self-esteem, such as self-hatred, guilt, and anger, can cause self-harm behaviors like cutting or burning yourself or abusing drugs or alcohol. Self-harm is a sign of emotional pain and a lack of coping skills.

Low Resilience
People with low self-esteem often find it hard to cope with challenging life events. This is because low self-esteem leads to feelings of futility and a lack of hope that things will get better. With this negative mindset, it’s difficult to bounce back from disappointments and setbacks in your life.

Relationship Problems
Low self-esteem can cause serious problems in your relationships. You may find it hard to trust your friends or partner, or you may seek approval or reassurance to the point that it becomes a problem. In more extreme cases, low self-esteem can cause you to stay in an abusive relationship because you feel like you deserve the abuse or you’re not worth saving from it.

Lack of Boundaries
A lack of boundaries can cause all sorts of problems in your life. When you have trouble saying “no” or you accept the abuse of toxic people in your life, you’re at the mercy of others, and the resulting problems further erode your self-esteem.

Connection Between Low Self-Esteem and Addiction

Low self-esteem is an important factor for drug or alcohol abuse. People with low self-esteem may use drugs or alcohol to feel better about themselves, numb emotional pain, or cope with underlying trauma. However, drugs and alcohol usually make things worse in the long-run, especially if the substance abuse transitions to addiction. According to a study published in the journal Addictive Behaviors, abusing drugs and alcohol typically leads to feelings of failure and a loss of control, and it can lead you to do things that make you feel even worse about yourself.(3)

Addiction is characterized by compulsive substance abuse despite the negative consequences that result, including financial, legal, relationship, or health problems. Addiction almost always has underlying causes, including trauma and mental illness, both of which can reduce self-esteem.

The National Institute on Drug Abuse stresses that once you develop an addiction, professional help is almost always needed to end it for the long-term. Willpower and good intentions are rarely enough to stop using for good. A high-quality treatment program addresses an individual’s multiple issues and needs so that drugs and alcohol are no longer needed in order to cope or to feel positive emotions.

Improving Self-Esteem in Addiction Treatment

A study published in the Journal of Social & Clinical Psychology found that people who have optimism, hope, and high self-esteem are less likely to abuse drugs or alcohol.

This includes people who are in recovery from a drug or alcohol addiction. Improving your self-esteem is an important aim in treatment because healthy self-regard can help reduce the risk of relapse.

A number of therapies are used in treatment to address the underlying issues of addiction. Cognitive-behavioral therapy (CBT) is the most commonly used treatment therapy for addiction, and it can help improve your self-esteem. During CBT, you’ll work to identify unhealthy thought and behavior patterns, including patterns of negative self-talk and behavior patterns that make you feel bad about yourself. Therapy helps you develop healthier, more positive ways of thinking about yourself and the world around you. It helps you stay mindful of your thoughts and emotions and how these affect your behaviors. With the help of a therapist, you’ll trace negative beliefs about yourself to their origins, and you’ll examine these beliefs and see if they’re valid.
Learning to recognize and reality test negative thoughts and feelings about yourself will ultimately help you come to the conclusion that you’re truly worthy of love and respect, especially from yourself.

Tips to Improve Your Self-Esteem

In addition to engaging in therapy during treatment, you can do a number of things to improve your self-esteem, such as:

Engage in Self-Care
Taking good care of your physical, mental, and spiritual health makes you feel better about yourself. Treat yourself well. Eat healthy food, exercise regularly, and get adequate sleep each night.

Remove Toxic People from Your Life
People who make you feel bad about yourself can perpetuate your low self-esteem. Leave toxic friends and family members behind, and seek out people in your life who lift you up.

Use Your Talents
Everyone has talents, and using them increases your self-confidence and self-esteem. Identify your strengths and talents and strive to use them every day. Allow yourself to be proud of your abilities.

Have Fun
Spending time engaged in activities you enjoy enhances your mood and can improve your feelings about yourself. Strive to have fun every day doing things you enjoy.

Set Boundaries
Boundaries are personal lines you draw for others and rules you create for yourself that help you feel safe and comfortable. Boundaries may include saying no to things you don’t want to do, accepting responsibility for your thoughts and actions, and enforcing rules about how you’ll allow other people to treat you. Having boundaries and sticking to them can help you improve your self-esteem by leaps and bounds.

Accept Compliments
People with low self-esteem can feel very uncomfortable when others compliment them. Your instinct may be to argue or to brush off the compliment, but force yourself to smile and say, “Thank you!” As you practice accepting kind words from others, it will become easier, and you’ll quiet your negative internal dialogue.

Be Kind to Yourself
Negative self-talk is a major source of low self-esteem. Whenever you notice your internal voice saying negative things about you, consciously stop the voice, and give it something positive to say. Instead of saying, “I’m a loser” after you make a simple mistake, say, “I’m lovable, and everyone makes mistakes.” Think about what you would say to a friend in the same situation, and respond to yourself using that lens. You’ll find that your self-esteem improves when you speak to yourself kindly.

Make a List of Positive Attributes
Write down everything you can think of about yourself that’s positive. Maybe you’re an amazing cook, a good listener, or have a great sense of humor. Maybe you’re fair, compassionate, or great with children. Write it all down, and refer back to your list every day. Add to it whenever you think of another positive trait.

Reality Test Negative Thoughts About Yourself
If you tend to jump to judgments about yourself without looking at the evidence, make a point to consciously evaluate the truth of the matter. For example, if you’re late picking up your mother from the airport and you think, “I’m such a bad son/daughter,” make yourself look at the facts. You’ll find that the truth is often far different from the automatic negative lines you feed yourself.

Stay Aware of Your Emotions
When you’re unaware of your emotions, you tend to react to them without thinking, which can keep you in a cycle of negative self-talk and unhealthy behaviors. Take the time to check in with yourself throughout the day. Identify the emotions you’re feeling and where they occur in your body. Trace the emotions back to their source, and work to mitigate the emotion. Don’t take negative emotions out on yourself.



Improve Self-Esteem to Improve Life

Low self-esteem can leave you with a negative view of the world and reduce your quality of life and sense of wellbeing. It can lead to substance use disorders and other problems in your life. By taking concrete steps to improve your self-esteem, you’ll enjoy greater motivation, better relationships, and a happier, healthier life.