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Psychoactive substance use is a significant public health issue. Developing effective preventive strategies to reduce its incidence requires a deep understanding of the motivations and risks underlying its development and maintenance. This study examines the associations between substance use risks, self-esteem, and body image perceptions within a Spanish sample (n=174). Data were collected using standardized instruments (ASSIST v3.1, RSES, BSQ 8-D, BIS) and an ad hoc questionnaire regarding aesthetic-related beliefs. Findings revealed that while alcohol (90.2%), tobacco (47.1%), and cannabis (29.3%) were the most prevalent substances used in the last three months, associated health risks were predominantly low. Significant negative correlations were identified between self-esteem and the risk of alcohol (ρ=−.155) and sedative use (ρ=−.221), as well as cocaine prevalence (ρ=−.155). Gender differences emerged, with males exhibiting higher risks for cannabis and stimulants, while females reported greater body image concern. Approximately 25.3% of the sample reported using substances for aesthetic purposes, primarily dietary supplements among men. Beliefs regarding the impact of consumption on physical appearance were predominantly negative. These results suggest that high self-esteem and negative aesthetic perceptions of substances serve as protective factors. Effective prevention strategies should incorporate body image and self-esteem as pillars of psychological resistance.