There is a definitive connection between self esteem and addiction– most notably in women’s addiction issues. In his famous hierarchy of needs, American psychologist Abraham Maslow put esteem in the second highest slot. All humans have a need to feel respected, including the need to have self-esteem and self-respect. Only when they are valued by themselves and others can they reach their full potential and the highest level on Maslow’s hierarchy: self-actualization. Low self-esteem plays a crucial role in the development of substance use disorders, especially in women. “Low self-esteem is … a strong predictor of alcohol use and abuse in young women,” reports The National Center on Addiction and Substance Abuse at Columbia University in Women Under the Influence. “One study found that girls, who at age 12 were low in self-esteem, were nearly two and a half times likelier to engage in heavy alcohol use … at age 15 than those higher in self-esteem. No such relationship was found in boys.” The self-image starts to form early in life. “Many kids decide whether they are ‘good’ or ‘bad’ or ‘smart’ or ‘stupid’ at a very young age… these initial self-concepts shape their choices, and in turn, their brains,” writes Maia Szalavitz, who misused cocaine and other drugs as a young woman. In girls and women, self-esteem is also strongly linked to body image. If they arrive at the conclusion that they are physically unappealing because they do not conform to perceived societal expectations, the impact on self-esteem can be devastating. It functions like a chronic, low-level depression but people are really suffering from misconceptions they have learned growing up. Any kind of sexual trauma intensifies feelings of worthlessness, and women are disproportionately affected. According to the National Sexual Violence Resource Center, one in five women in the United States will be raped at some point in their lives (for men the rate is one in seventy-one). One in four girls will be sexually abused before they turn 18 and nearly one in ten women will be raped by an intimate partner in her lifetime. In view of these horrendous statistics, it is hardly surprising that a large number of women and girls discover substance use as a method to numb the emotional pain caused by sexual violence and low self-esteem. Hamid Reza Alavi, Ph.D., studied the role of self-esteem in tendency toward drugs, theft, and prostitution, and concluded that “those who are involved in addiction, theft and prostitution have a lower self-esteem compared with the ordinary person.” Alavi described the features of low self-esteem as “those in which the individual does not think he/she is important, expects others to humiliate him, does not trust others, and thinks nobody likes him/her. Such an individual also feels loneliness and separation from others, and is not interested in himself and others.” If this misconception of the self is not corrected, a substance use disorder can easily develop. But using drugs and alcohol doesn’t alleviate the suffering and only temporarily numbs the emotional pain while causing extremely negative repercussions. Once the addiction cycle of using, sobering, craving, and using again kicks in, feelings of shame about substance abuse lower self-esteem even further. In addition, the perception of being unimportant can be a barrier to seeking treatment. Why would anybody bother to heal such a worthless person? The only escape is learning how to feel good about oneself without using drugs and alcohol. Effective addiction treatment needs to address any existing trauma and self-esteem issues, especially in females. The women’s rehab at Lakeview Health employs the Covington model to do that. Patients receive treatment in four modules called Self, Relationship, Sexuality, and Spirituality in a gender-responsive environment. In the Self module, patients learn about the sources of self-esteem, and they consider the effects of sexism, racism, and stigma on the sense of self. In the Relationship module, the women review their relationship histories—including possible histories of interpersonal violence—and make decisions about how they can build healthy support systems. In the Sexuality module, women explore the connections between addiction and sexuality, body image, sexual identity, and sexual abuse. “The women learn to be assertive,” says Lakeview therapist Desiree Lewis. “They’re re-connecting with the natural vitality they once had before the drug use. They learn that it is more important to be your authentic self than to look pretty to please others.” The integrative approach at Lakeview doesn’t simply focus on abstinence from drugs or alcohol but looks at the patient holistically, her mind, body, and spirit. In the fourth of Dr. Covington’s modules patients are given an opportunity to experience aspects of spirituality and to create a vision for their immediate future free of drugs and alcohol. This vision is an important guide on the road to recovery and to reaching the highest level in Maslow’s hierarchy of human needs.