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Understanding the Link Between Narcissism and Alcoholism

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Written By: Ashley Laderer

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Clinically Reviewed By: Rebecca Holland

October 3, 2024

7 min.

Narcissistic personality disorder (NPD) and alcohol use disorder (AUD) have profound impacts on relationships, behaviors, and overall well-being. Read on to learn more about both disorders and how to treat them.

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Narcissism, formally known as narcissistic personality disorder (NPD), and alcoholism, now referred to as alcohol use disorder (AUD), are two distinct mental health conditions. Sometimes, they’re comorbid, meaning they occur together. NPD is characterized by inflated self-importance and lack of empathy, while alcohol use disorder involves an inability to control alcohol consumption despite negative impacts. When these two disorders co-occur, their effects can amplify each other, leading to more severe emotional, behavioral, and interpersonal challenges. Here’s what you need to know about NPD and alcohol use disorder, including how they intersect and how to treat them. 

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Introduction to narcissism and alcoholism 

Learning about the symptoms of each mental health disorder is important to understand how NPD and AUD intersect. Let’s dive into the details of each disorder. 

What is narcissistic personality disorder (NPD)?

Narcissism is generally linked to arrogance, self-importance, and lack of empathy. Many people colloquially throw around the term “narcissism” or call someone a “narcissist,” but NPD is a mental health diagnosis requiring specific criteria. However, it’s certainly possible for someone to exhibit narcissistic tendencies but not meet the NPD diagnostic criteria, says Sarah Lyter, LCPC, MA, a Charlie Health Clinical Supervisor.

For someone to receive a formal NPD diagnosis, they have to meet at least five of the criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The criteria are as follows:

  • Having a sense of grandiosity and self-importance
  • Fantasizing about power, success, and beauty
  • Believing they’re unique and special and should only associate with or be understood by other special, high-power people 
  • Needing excessive, constant admiration and praise 
  • Feeling unreasonably entitled to special treatment 
  • Taking advantage of others or exploiting others for their own gain
  • Lacking empathy, disregarding other people’s needs and feelings
  • Feeling jealous of others and believing that other people are jealous of them
  • Acting arrogant or egotistical 

What narcissism looks like

Under the umbrella of narcissism, there are a few subtypes. Regardless, someone with NPD has to meet at least five of the above DSM criteria, but there may be some differences. Here’s a breakdown of different presentations of narcissism:

Grandiose narcissism/overt narcissism

These individuals are very outwardly grandiose, arrogant, self-absorbed, and attention-seeking. Because of this, a grandiose narcissist is often the easiest to spot. They also exploit people and lack empathy.

Covert narcissism/vulnerable narcissism

These narcissists are hypersensitive to criticism, insecure, and jealous. Since they may seem shy or anxious, vulnerable narcissists are harder to spot. Their narcissistic tendencies don’t come across as obviously as those of a grandiose narcissist.

Malignant narcissism

This is the most harmful form of NPD. A malignant narcissist may lie frequently, exhibit aggressiveness, have psychopathic traits, manipulate people, and even enjoy inflicting pain on others. Their narcissistic behavior is often dangerous and abusive

What is alcoholism?

Alcoholism, technically known as alcohol use disorder (AUD), is a form of substance use disorder. Some people may also refer to it as alcohol abuse or alcohol addiction. One of the main indicators of addiction is “if someone’s drinking is causing them problems, and they keep doing it anyway, and can’t stop drinking or don’t want to stop drinking,” Lyter says. The DSM-5 outlines 11 specific criteria for a diagnosis of alcohol use disorder, including:

  • Drinking greater amounts of alcohol or for a longer period than you intended to
  • Trying to stop or limit alcohol consumption but not being able to do it
  • Spending a lot of time drinking, feeling sick, or being hungover
  • Craving alcohol so badly that you can’t think of anything else
  • Drinking or being sick/hungover interfering with your home life, family, job, or school 
  • Continuing to drink even if it’s causing problems with your relationships
  • Choosing to drink over other important or fun activities
  • Engaging in dangerous or risky behavior during or after drinking
  • Continuing to drink even if it’s causing you mental health or physical health problems
  • Having increased tolerance (needing to drink more alcohol to get the same effect)
  • Experiencing withdrawal symptoms (like shakiness, nausea, trouble sleeping, racing heart, or even seizures) after drinking, when the effects of alcohol wears off

The severity of alcohol use disorder ranges from mild to severe. 

  • Mild AUD: 2-3 symptoms
  • Moderate AUD: 4-5 symptoms
  • Severe AUD: 6 or more symptoms 

How do narcissism and alcoholism intersect? 

There’s a significant overlap in people with personality disorders and substance use disorders in general. The National Institute of Mental Health estimates that 22.6% of people with any personality disorder also have a substance use disorder. Other research found that 40.6% of people with NPD engage in substance abuse. 

Narcissism and alcohol abuse both have great impacts on mental health. When they co-occur, the effects may amplify each other. Here are a few examples:

More likely to cope in unhealthy ways

“Narcissists can often have a lot of feelings of envy, inadequacy, and pressure, so they’re more likely to cope using substances,” Lyter says. 

More likely to engage in risky behavior

Since narcissists are very grandiose, they may be more likely to engage in risky behavior, whether that’s excessive substance use itself or reckless behavior while drinking, says Lyter. In their grandiosity, a narcissist with AUD might even drink excessively to show off, seem “cool,” or try to impress others

More likely to be less empathetic

Many narcissists lack empathy for others. Lyter says this can be further exacerbated by alcohol abuse. 

Less likely to admit they have a problem

Research shows narcissists are less likely to believe they would have a problem with substance abuse in the first place and less likely to admit they have a problem –– leading to treatment delays. 

How do narcissism and alcoholism impact relationships? 

These two disorders, especially when occurring together, have a major impact on relationships, whether with family, friends, or romantic partners. Here are a few ways these disorders negatively impact interpersonal relationships: 

Instability within relationships

Relationships may be unstable with increased conflict, Lyter says. There may be lots of arguments and disagreements without healthy conflict-resolution skills. 

Lack of accountability

Lyter says Individuals with both disorders may lack accountability for wrongdoings. Narcissists often blame others and refuse to take ownership. 

Greater risk of abuse

Not all narcissists are abusers, but some may engage in narcissistic abuse, which is typically emotional abuse. Additionally, Lyter says there’s an increased risk of domestic violence in people with alcohol use disorder. 

Treatment for narcissism and alcohol use disorder

Whether you have narcissistic personality disorder, alcohol use disorder, or both, getting professional help is crucial. Personality disorders like NPD are lifelong, but you can learn ways to cope with them, build self-awareness, manage symptoms, and have healthier relationships. The stakes for treating alcohol use disorder are even higher. Lyter says alcohol use disorder is severe, progressive, and can eventually lead to death if not treated. Both narcissists and people with AUD may have trouble recognizing and admitting that they have a problem –– but once they acknowledge it and actively put in the work in therapy, they can improve.

Treatment for narcissistic personality disorder 

Narcissists typically don’t seek out help on their own. They might go to therapy if a loved one is very concerned about their worsening behavior, or they might go to therapy for another issue altogether, like depression. Then, a therapist ends up diagnosing NPD. Some specific types of therapy used to help a narcissist include: 

There aren’t any psychiatric medications specifically approved for treating NPD, but if you have a co-occurring mental health condition, you may receive medications to treat those additional symptoms. While these meds won’t directly treat NPD symptoms, they can improve overall mental well-being.  

Treatment for alcohol use disorder (AUD)

Whether someone with AUD has admitted they need help or loved ones have staged an intervention, the first phase of treatment is detox and withdrawal. This is when your body gets rid of all the alcohol in your system. It’s important to do this safely under medical care, especially if your AUD is severe, to avoid dangerous withdrawal symptoms like seizures. 

Once you’ve safely detoxed, more in-depth treatment can begin. Depending on the severity of AUD, some people may choose residential treatment, while others may choose outpatient treatment. Types of therapy that can help alcohol use disorder include:

Support groups play a large part in recovery, Lyter says. One of the most common examples is Alcoholics Anonymous (AA), but Lyter says you can choose something other than a 12-step program if it’s a better fit for you. She notes Refuge Recovery as a Buddhist-based group, Celebrate Recovery for a Christian approach, or Smart Recovery as a more secular, CBT-based group. It’s all about finding the best fit for you.

Additionally, if your mental health care team thinks it’s the right fit for you, psychiatric medication may be prescribed. There are a few medications that can help curb cravings and help you stay away from drinking, including:

  • Disulfiram
  • Naltrexone
  • Acamprosate
A man with alcoholism lays on his couch.

How Charlie Health can help

If you or a loved one struggles with narcissism and alcoholism, Charlie Health can help. Our virtual intensive Outpatient Program (IOP) provides personalized mental health treatment for individuals with serious mental health conditions, including personality disorders, substance use disorders, and co-occurring conditions. Our clinicians meet you where you are in your recovery journey and incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. Fill out the form below or call us to start your recovery journey today.

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