It is written from the viewpoint of someone newly sober (three months) that is realizing the enormity of the problems of his addiction, and how badly he had treated those whose only crime was that they loved someone who didn't act lovably. The self-hatred that is constantly referenced in the song, that is its title, is something that is very real in early recovery. Amends seem to be too monumental a task to even contemplate, and as the full scope of the damage becomes clearly, it truly does seem to the person in early recovery that the partner/child really ought to hate him--because he would deserve it. It is a measure of how soul-deadening active addiction is that the concept of forgiveness, of loving someone even though they do hurt us, is beyond us.
It is also a measure of the self-centeredness that is the actual disease of addiction. It relieves the addict of the responsibility of making amends if the people they are owed to hate him and don't want him around. It also is a convenient excuse, both to not examine the addiction period in detail, and also provides a ready-made reason to relapse. When I heard, and still hear, this song, this is what I hear, what I see--not the remorse, but the self-interest and absorption that underlies it. This is nothing more or less than the recently-sober singer trying to backdoor-manipulate either forgiveness or a reason to give up.
Seeing it for it is does not make it less genuine. Indeed, this is a necessary phase of true recovery. The positive of the song and the sentiments is not what is being said, but the facts that the effort is there and that they are being said out loud. A closed mouth does not get fed; if the addict does not voice these sort of feelings, they cannot be (hopefully gently) influenced to see that the disease of addiction, contrary to what they want to believe, is still alive and kicking after the substance is down. It's the self-centeredness, the obsession with themselves, that needs to be addressed for long-term recovery to take place, not merely staying abstinent for a length of time.