Many thinking distortions are not necessarily related to substance use. For example, fear of rejection, anxiety, isolation, and despair often result from low self-esteem. Many of the quirks of addictive thinking are psychological defenses against these painful feelings, and these symptoms are due to the persistence of the distorted self-image that began in childhood.
I would argue that rather than low self-esteem, it is lack of understanding of God's love and one's identity in Christ that leads to these desires to control or hide one's inadequacy. Because we are inadequate on our own. That low self esteem is warranted outside the cross.
