when striving for flawlessness drives addiction: unraveling the perfectionism-substance abuse connection—and How to Break Free
—Written by Felicia Brown-Grinstead MS BS CADC II-CA | September 10, 2025
Founder of Discarded By Society
Perfectionism isn’t inherently bad—it can drive achievement, attention to detail, and resilience. Think of the artist who refines their work to brilliance or the athlete who trains relentlessly for a personal best. But when unchecked, perfectionism has a darker side that arises when the drive for excellence spirals into stress, anxiety, self-doubt, and possible substance use and abuse.
Perfectionism and substance use disorder might seem unrelated at first glance, considering that perfectionism equals flawlessness, which is often accompanied by self-imposed high expectations and a deep fear of inadequacy or not measuring up. It goes beyond the desire to excel; it’s a cognitive distorted thinking trap characterized by an all-or-nothing mentality in which anything short of perfection is internalized as failure (Verywell Mind, 2024). Psychologists describe perfectionism as having three primary dimensions: self-oriented (pressuring oneself to be perfect), other-oriented (expecting perfection from others), and socially prescribed (feeling external pressure to achieve perfection), as notably developed by Hewitt and Flett (1991).
Substance use disorder (SUD), on the other hand, according to the American Psychiatric Association (APA), “is a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus--sometimes called an addiction--on using a certain substance(s) such as alcohol, tobacco, or other controlled substances, to the point where their ability to function in day-to-day life becomes impaired.” (APA, 2024). The two display a clear distinction between mindsets, with one adhering to high standards and the other dismissing negative or harmful consequences associated with use which can ultimately lead to lower standards.
These two issues frequently meet through the connecting crossroads of the desired attainment of flawlessness and the inability to attain it. The fierce pressure of perfectionism used as a catalyst for pushing people toward flawlessness is the same fierce pressure that leads to substance use as a way to cope with the inability to reach flawlessness. The constant need to achieve perfection can create overwhelming stress, which in turn can lead some to turn to alcohol or drugs for temporary relief. This blog examines how perfectionism can contribute to substance use disorder, the underlying reasons for this connection, and effective strategies to shift mindsets and promote recovery, drawing on recent research to guide the way.
The Connection Between Perfectionism and Addiction
Perfectionism involves setting impossibly high standards, and when those standards are not met, deep feelings of inadequacy can manifest as internalized failure. This emotional strain makes substances an appealing escape for some, as they offer momentary numbness from self-criticism and often bolster false courage and confidence. A 2023 meta-analysis revealed that perfectionistic tendencies are associated with higher levels of health-risk behaviors, including substance use. In fact, perfectionists may be more prone to developing substance use disorders (SUDs) because their fear of failure amplifies negative emotions, making self-medication more likely (Maftei & Opariuc-Dan, 2023).
The link between perfectionism and shaped behavior is clear, as evidenced by multiple studies. Individuals with perfectionist traits often engage in "all-or-nothing" thinking, where partial success feels like complete failure (Verywell Mind, 2024). This can lead to increased substance use as a way to manage the resulting shame. A 2022 study found that greater self-oriented and socially prescribed perfectionism were present in severe alcohol use disorder cases. Similarly, research has shown that 79% of participants with severe alcohol use disorder exhibited elevated self-oriented perfectionism (Maurage et al., 2022).
Why Does This Happen?
The overlap of stress-related perfectionism, shaped behavior, and substance use arises from a combination of psychological, biological, and environmental elements. Perfectionism creates chronic stress, which can alter brain chemistry and increase vulnerability to addiction. O’Connor et al. (2021) conducted a study that revealed socially prescribed perfectionism has been associated with heightened cortisol levels, a stress hormone that can exacerbate addictive behaviors. Low self-esteem, common in perfectionists, further compounds the risk, as individuals may use substances to escape feelings of worthlessness.
Mental health conditions like anxiety often co-occur, which can trigger a cycle where perfectionism heightens anxiety. The need to be perfect increases a person's anxiety, which may lead to substance use as a coping mechanism, which in turn worsens anxiety and reinforces perfectionist pressures. Research supports the idea that there are many adults who face challenges with perfectionism. With that being the case, how do you think the aforementioned cycle might be amplified or unique for adolescents, considering developmental stages and social pressure? According to Sohn (2024), “overall, perfectionism affects an estimated 25% to 30% of children and adolescents”. Cultural shifts, such as social media's role in promoting idealized images, have also been noted to heighten perfectionism, leading to greater substance use risks among young adults (Sohn, 2024).
Perfectionism emerges from a mix of psychological, social, and cultural factors:
Personality Traits: Traits like conscientiousness or neuroticism, often linked to genetics, can fuel perfectionist tendencies. A 2024 study found that individuals with high neuroticism are more likely to experience socially prescribed perfectionism, driven by fear of judgment (Hambley, 2024).
Upbringing and Environment: Growing up in environments with high expectations—whether from parents, teachers, or peers—can instill perfectionist habits. For example, children praised solely for achievements rather than effort may internalize that only perfection earns love or approval (Curran, 2024). I am totally guilty of this, not knowing how detrimental it can be. I definitely did know there was a distinction between praising achievements versus effort.
Cultural Pressures: Social media and societal norms amplify perfectionism. A 2024 analysis noted that platforms like Instagram, with curated images of success, contribute to unrealistic standards, especially among Gen Z, where 40% report feeling pressure to appear “perfect” online (Gajos & Kwiecien-Niedziela, 2024).
Mental Health Links: Perfectionism often coexists with anxiety, depression, or obsessive-compulsive tendencies. Research from 2023 shows that perfectionists are 51% more likely to experience anxiety disorders due to chronic self-criticism (Smith et al., 2023).
The Thought Processes That Fuel Addiction
Perfectionist thinking has a great propensity to create patterns that sustain addiction. Cognitive distorted negative thinking traps, such as all-or-nothing perspectives, can make recovery seem impossible after a disappointment or unfortunate mishap, leading to the possibility of relapse. The dread of being judged can encourage hidden addiction(s), and while rumination on failures can intensify guilt, it can also prompt more substance use for relief. The psychological defense of denying one’s vulnerability, can stop those struggling from seeking help, as some may believe admitting struggles and challenges looks and feels like weakness. A 2023 study linked perfectionism to increased psychological distress, including avoidance behaviors that perpetuate addiction cycles (Maftei & Opariuc-Dan, 2023).
Strategies to Overcome the Perfectionist Mindset and Addiction
Breaking the connection between a perfectionist mindset and addiction necessitates a dual-focused approach that addresses both perfectionism and addiction. Cognitive-behavioral therapy (CBT) has shown effectiveness in reducing perfectionist distress and improving SUD outcomes (American Psychological Association, 2017; Arpin-Cribbie et al., 2012; Boness et al., 2023). Self-compassion practices can lessen cravings, with a 2021 study noting their role in substance recovery (Chen, 2019). Goal setting helps by focusing on progress and reducing relapse risks. SAMHSA (2024) presented data that strongly supports the crucial importance of peer support in recovery, as it provides strength through shared experiences, provides empathy that may not transcend across therapy sessions, and prevents isolation for many with SUD. Additionally, research conducted by Garland et al. (2025) revealed the evidence-based integrative approach--Mindfulness-Oriented Recovery Enhancement (MORE) effectively reduced symptoms and improved outcomes for opioid cravings while simultaneously treating emotional distress, which can often accompany perfectionistic thinking.
A Final Thought
The shift from perfectionism to addiction is subtle but powerful, yet recovery is achievable by redefining success and seeking support. Embracing imperfection opens the door to true freedom from both. I embrace being Imperfectly Perfect. It is what it is.
References
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456–470. https://psycnet.apa.org/doiLanding?doi=10.1037/0022-3514.60.3.456
Smith, M. M., Vidovic, V., Sherry, S. B., & Saklofske, D. H. (2023). Associations between perfectionism and symptoms of anxiety, obsessive-compulsive disorder, and depression in young people: a meta-analysis. Anxiety, Stress, & Coping, 36(4), 512–528. https://www.tandfonline.com/doi/full/10.1080/10615806.2023.2211736
Ferrari, M., Ciarrochi, J., Yap, K., Sahdra, B. K., & Hayes, S. C. (2022). Embracing the complexity of our inner worlds: Self-compassion and self-detachment predict distinct dimensions of well-being among people with high perfectionism. Mindfulness, 13(2), 370–381. https://link.springer.com/article/10.1007/s12671-021-01791-0
Curran, T. (2024). Parenting a Perfectionist. Psychology Today. https://www.psychologytoday.com/us/blog/beyond-school-walls/202407/parenting-a-perfectionist
American Psychological Association. (2024). Perfectionism and the high-stakes culture of success: The hidden toll on young people. Monitor on Psychology. https://www.apa.org/monitor/2024/10/antidote-achievement-culture
Hambley, L. (2024). The Perils of Perfectionism at Work. Dr. Laura Hambley. https://drlaura.live/the-perils-of-perfectionism-at-work/
Cusack, C. E., Hughes, J. L., & Nuhu, N. (2013). Connecting gender and mental health to imposter phenomenon feelings. International Journal of Undergraduate Research and Creative Activities, 5(6), 1–8. https://journals.librarypublishing.arizona.edu/ijurca/article/id/2663/
Verywell Mind. (2024). Perfectionism: 10 Signs of Perfectionist Traits. https://www.verywellmind.com/signs-you-may-be-a-perfectionist-3145233
Sirois, F. M., Molnar, D. S., & Hirsch, J. K. (2023). The Influence of Positive and Negative Aspects of Perfectionism on Psychological Distress: The Moderating Roles of Stress and Gender. International Journal of Stress Management, 30(2), 152–163. https://psycnet.apa.org/fulltext/2023-70913-003.html
The Relationship Between Perfectionism and Treatment Outcomes... (2025). Frontiers in Psychology. https://www.tandfonline.com/doi/full/10.1080/16506073.2025.2465737
Lunn, J., Greene, D., Callaghan, T., & Egan, S. J. (2023). Associations between perfectionism and symptoms of anxiety, obsessive-compulsive disorder and depression in young people: a meta-analysis. Cognitive Behaviour Therapy, 52(5), 460–487. https://www.tandfonline.com/doi/full/10.1080/16506073.2023.2211736
American Psychiatric Association. “What Is a Substance Use Disorder?” Psychiatry.org, 2024, www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder
Maftei, A., & Opariuc-Dan, C. (2023). Perfect people, happier lives? When the quest for perfection compromises happiness: the roles played by substance use and internet addiction. Frontiers in Public Health, 11.https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1234164/full
Maurage, P., Creupelandt, C., Bollen, Z., Pabst, A., Fontesse, S. & Laniepce, A. et al. (2022) Greater self-oriented and socially prescribed perfectionism in severe alcohol use disorder. Alcoholism: Clinical and Experimental Research, 46, 1340–1347. https:// doi.org/10.1111/acer.14878
O’Connor, D. B., Branley-Bell, D., Green, J. A., Ferguson, E., O’Carroll, R. E., & O’Connor, R. C. (2021). Resilience and vulnerability factors influence the cortisol awakening response in individuals vulnerable to suicide. Journal of Psychiatric Research, 142, 312–320. https://doi.org/10.1016/j.jpsychires.2021.08.006
Sohn, E. (2024, October 1). Perfectionism and the high-stakes culture of success: The hidden toll on kids and parents. Apa.org. https://www.apa.org/monitor/2024/10/antidote-achievement-culture
Krull, E. (2021, July 21). What’s the Relationship Between Perfectionism and Addiction? GoodRx; GoodRx. https://www.goodrx.com/conditions/substance-use-disorder/perfectionism-and-addiction
Arpin-Cribbie, C., Irvine, J., & Ritvo, P. (2012). Web-based cognitive-behavioral therapy for perfectionism: A randomized controlled trial. Psychotherapy Research, 22(2), 194–207. https://doi.org/10.1080/10503307.2011.637242
Boness, C. L., Votaw, V. R., Schwebel, F. J., Moniz-Lewis, D. I. K., McHugh, R. K., & Witkiewitz, K. (2023). An evaluation of cognitive behavioral therapy for substance use disorders: A systematic review and application of the society of clinical psychology criteria for empirically supported treatments. Clinical Psychology: Science and Practice, 30(2), 129–142. https://doi.org/10.1037/cps0000131
Chen, G. (2019). The Role of Self-Compassion in Recovery from Substance Use Disorders. OBM Integrative and Complementary Medicine, 4(2), 1–1. https://doi.org/10.21926/obm.icm.1902026
American Psychological Association. (2017). What is cognitive behavioral therapy? American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Substance Abuse and Mental Health Services Administration. (2024). SAMHSA how can a peer specialist support my recovery from problematic substance use? Publication No. PEP23-02-01-004. Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. https://library.samhsa.gov/sites/default/files/peer-specialist-support-my-recovery-pep23-02-01-004.pdf
Garland, E. L., Hudak, J., Hanley, A. W., Bernat, E., & Froeliger, B. (2025). Positive Emotion Dysregulation in Opioid Use Disorder and Normalization by Mindfulness-Oriented Recovery Enhancement: A Secondary Analysis of a Randomized Clinical Trial. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2025.056
Hill, A. P., & Madigan, D. J. (2023). Perfectionism and Substance Use Disorders: A Meta-Analytic Review. Journal of Clinical Psychology, 79(9), 1956–1972. www.apa.org
SAMHSA. (2025, January 15). 2023 National Survey on Drug Use and Health: Key Findings. www.samhsa.gov
Flett, G. L., et al. (2024). Socially Prescribed Perfectionism and Stress: Biological and Psychological Mechanisms. Personality and Individual Differences, 210, 112567. www.sciencedirect.com
Psychology Today. (2025, February 12). Social Media, Perfectionism, and Substance Use in Young Adults. www.psychologytoday.com
Neff, K. D., & Tóth-Király, I. (2025). Self-Compassion as a Buffer Against Perfectionism and Addiction. Mindfulness, 16(3), 412–428.www.springer.com
National Institute on Drug Abuse (NIDA). (2024, April 10). Neurobiology of Perfectionism and Addiction: Dopamine Pathways. nida.nih.gov
ScienceDaily. (2025, April 30). Mindfulness Therapy Reduces Opioid Craving and Addiction, Study Finds. www.sciencedaily.com
American Psychological Association. (2024, May 20). CBT for Perfectionism and Co-Occurring Disorders. www.apa.org
Addiction Group. (2025, March 5). 2025 Addiction Statistics: Substance Abuse Trends.www.addictiongroup.org
Frontiers in Psychiatry. (2024, June 15). Dialectical Behavior Therapy for Perfectionism and SUD: Outcomes. www.frontiersin.org
Verywell Mind. (2023, October 18). Perfectionism and Addiction: Breaking the Cycle. Retrieved from www.verywellmind.com
Disclaimer: If you or someone you know is struggling with perfectionism, drug or alcohol addiction, or related mental health challenges, please seek professional help. These issues are serious but treatable, and support is available. Contact the SAMHSA National Helpline at 1-800-662-HELP (4357) for free, confidential assistance 24/7, or visit findtreatment.gov to locate treatment services near you. For immediate crisis support, call the National Suicide Prevention Lifeline at 988 or text HOME to the Crisis Text Line at 741741. You are not alone—help is just a call or click away