This earlier post about budding British tenor Paul Potts generated quite a bit of interest, particularly the difficulties that the humble Potts has had in overcoming a lack of confidence to perform on stage. This link from that earlier post discusses how common such insecurity is among opera singers, and this International Herald Tribune article reports that even established opera stars struggle mightily with the manifestations of insecurity:

[Opera] insiders agree that heightened competition, unyielding sponsor demands and the weight of stardom are leading to excesses that invite comparisons of opera to sports tarnished by doping scandals.
Some attempts to stay on top are relatively harmless, like popping a beta blocker to soothe the butterflies before stepping on stage. But others are more alarming.
Singers often overuse steroids in the form of cortisone to control inflamed vocal cords ó sometimes in amounts that can permanently impair their abilities, say performers and their doctors. Others drink too much. Still others snort cocaine, according to insiders.
Inability to cope sometimes turns into tragedy ó as in the case of American tenor Jerry Hadley, who killed himself last month after what friends said was a prolonged bout of depression and reported financial and drinking problems. [. . .]
To deal with the pressures, “soloists are taking beta blockers to control their angst, some tenors take cortisone to push their voice high, and alcohol is everywhere,” [Tenor Endrik Wottrich] said. “The real pressure is no longer good old stage fright but comes from a new dimension that has penetrated opera ó it now lives from glamour, and normal human mistakes are a disruption in such an environment.” [. . .]
In the past 50 years, stages have grown in size, orchestral instruments accompanying singers have become stronger and opera seasons have lengthened. Adding to the pressure, singers get paid by the performance ó no money for no shows.
Good singers are now in demand all year round, globe-trotting from one hemisphere to another. And even those who avoid long-distance travel often have little time between the late spring end of the subscription season, the start of rehearsals for summer festivals, and tours promoting their own recordings. [. . .]
Still, physicians who treat singers urge them to resist the temptation to perform at any cost. Some, they say, overdose without knowing it, as they travel from gig to gig in one city after the another without keeping track of cortisone treatments that ó if overdone ó can destroy a voice.

Read the entire article. Along the same lines, see “It wouldn’t by Opera without an outrage.”