Self-esteem has been studied among patients with substance use disorders. Issues with self-esteem have been speculated to account for vulnerability to substance use disorders. Consequently, heroin dependence or heroin addiction has been associated with decreased self-esteem in observational studies as compared to healthy controls. However, self-esteem in individuals with heroin use disorders may be similar to individuals with other substance use disorders, or those with difficult life circumstances like incarceration. Several correlates of lowered self-esteem have been assessed in individuals with heroin dependence, including stigma, alexithymia, and adverse childhood experiences. Researchers have attempted to look at changes in self-esteem in longitudinal course of time, and both increases and decreases in self-esteem have been observed. Interventional studies have seen changes in self-esteem as individuals receive substance use disorders (including opioid use disorders) receive interventions like group cognitive therapy. Several conceptual issues need to be considered while interpreting literature pertaining to self-esteem in individuals with heroin dependence.