Narcissistic Personality Disorder and Alcoholism: The Facts (2024)

Narcissistic personality disorder (NPD) and alcohol use disorder (AUD) are closely linked. Both are mental health conditions that can damage relationships, cause personal distress, and undermine a person's quality of life and sense of well-being.

NPD and AUD frequently co-exist and can increase the effects of each other. People with a pattern of narcissism often turn to alcohol to reinforce a false sense of grandiosity. People with AUD, also known as alcoholism, can display patterns of narcissism, including self-absorption and an underlying craving for admiration.

This article discusses the similarities and differences between people with narcissistic personality disorder and those with alcohol use disorder. It also discusses ways that they are diagnosed and treated.

Similarities and Differences: Narcissism and Alcoholism

Narcissistic personality disorder is a personality disorder characterized by patterns of behavior, including feelings of entitlement, a need for admiration, and high sensitivity. There are two types: grandiose narcissists who have high self-esteem and vulnerable narcissists who have low self-esteem.

Alcohol use disorder is a type of substance abuse disorder where a person cannot control or stop their alcohol use. The symptoms can be mild, moderate, or severe.

Both NPD and AUD are mental health conditions classified in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Both conditions frequently co-occur. According to a 2019 study in Behavioral Medicine, 40.6% of NPD have substance abuse problems. On the flip side, grandiose and vulnerable NPD were both independent factors for alcohol abuse, concluded a 2019 study in the Journal of American College Health.

How They Differ

Personality disorders like NPD are those in which a person has a rigid and unhealthy pattern of thinking, functioning, and behaving. Substance abuse disorders like AUD are characterized by mental and physical addiction.

Both AUD and NPD have distinctive symptoms and features that occur independently of each other.

Where They Overlap

It is not uncommon for two mental health conditions to co-exist (referred to as a comorbidity). The occurrence of two such conditions is called a dual diagnosis.

A dual diagnosis of NPD and AUD is not uncommon. For this reason, mental health professionals will routinely screen for substance abuse when diagnosing a personality disorder or screen for behavioral concerns when a person has a substance abuse disorder.

NPD and AUD overlap in a number of key ways and can reinforce each other. These include characteristics like:

• Avoidant behaviors: People with NPD and AUD find ways to avoid unpleasant or uncomfortable emotions.
• Shifting blame: People with NPD and AUD find ways to blame others or shift responsibility for their own actions.
• Unpredictable behaviors: People with NPD and AUD can respond erratically or exhibit extreme mood shifts.
• Relationship problems: People with NPD and AUD exhibit self-destructive tendencies and have difficulty maintaining relationships both socially and in the workplace.
• Lack of self-control: Despite the harm their behaviors can cause, people with NPD and AUD will persist with the behaviors or feel they have no control over their actions.
• Prior trauma: People with NPD and AUD are often victims of past sexual, physical, or emotional abuse or neglect. This includes living with someone with a mental illness or addiction.
• Distress: Despite avoidance behaviors, NPD and AUD are ultimately characterized by deep feelings of distress and anxiety.
  

Diagnosing Alcoholism and Narcissism

Making a dual diagnosis of NPD and AUD can be challenging and something that only a qualified mental health professional can make.

Exhibiting narcissistic behaviors when drunk, for example, doesn’t inherently mean that a person has NPD. Alcohol can influence narcissistic behaviors, such as arrogance, self-importance, and feelings of superiority that aren’t otherwise present when sober.

Similarly, using alcohol doesn't mean a person with NPD has AUD, even if there have been incidents of extreme intoxication.

All personality and substance abuse disorders are diagnosed based on a strict set of criteria described in the DSM-5. While there is room for interpretation, a person with NPD and/or AUD must meet a minimum standard before a diagnosis can be delivered with confidence.

By way of example, a person must meet five of nine possible criteria for NPD to be diagnosed, ranging from grandiosity to a lack of empathy.

For AUD to be diagnosed, a person must meet one of four possible criteria for alcohol abuse, three of seven possible criteria for alcohol dependence, and two of 12 possible criteria for AUD symptoms.

Moreover, each mental health condition must be independently diagnosed. By doing so, a person is less likely to be "over-treated" for a condition they may not actually have.

One example is being referred to Alcoholics Anonymous (AA) on the presumption of AUD. In such cases, a person might start to question the diagnosis and abandon treatment altogether even if another condition, such as NPD, actually exists.

Treating Alcoholism and Narcissism

The treatment of NPD and AUD should ideally be delivered simultaneously, especially if there is severe addiction or depression. With that said, there are challenges to delivering appropriate care for the dual diagnosis.

For instance, NPD and AUD both involve psychotherapy, but the formats for each can vary. For NPD, it may involve individual or group counseling using cognitive behavioral therapy,schema-focused therapy,anddialectical behavior therapy. For AUD, group approaches such as AA and other twelve-step addiction programs are common.

Treating each condition independently can sometimes lead people to "choose one over the other," especially if care is not coordinated. This is especially true if medications are prescribed.

With NPD, for example, there are no drugs specifically used for the treatment of the personality disorder, but antidepressants or anxiolytics may be prescribed if depression or anxiety is present.

On the other hand, the treatment of AUD can involve several different drugs such as benzodiazepines to treat anxiety and insomnia, Topamax (topiramate) to treat alcohol dependence, Campral (acamprosate) to ease alcohol withdrawal, and Revia (naltrexone) to reduce alcohol cravings.

Again, if care is not coordinated by a qualified mental health professional, the overlapping treatments can lead to drug interactions, unintended side effects, and the possible abandonment of treatment.

Outlook With Narcissism and Alcoholism

With any mental health condition, the outlook is almost invariably better if you are treated than not treated. AUD and NPD are no exception.

AUD Prognosis

Alcohol abuse disorder is characterized by periods of sobriety and relapse. Even so, with a combination of therapy, support, and persistence, around a third of people with AUD will maintain sobriety for at least a year and sometimes for decades. Medications like Campral, Topamax, and Revia have greatly improved AUD recovery rates.

The outlook is even better in people with mental illness who abuse alcohol and other substances.

With that said, not every mental health issue is easily resolved. NPD is a case in point.

NPD Prognosis

Narcissistic personality disorder can be one of the more challenging mental health conditions to treat. Even with therapy, progress can be slow in changing the core behaviors.

Because a person with NPD will often approach therapy with ambivalence or negative feelings, they are more likely to give up prematurely. They also tend to have a low tolerance for stress and will often give up and walk away than deal with it.

Patience and support are therefore needed to ensure the best possible outcomes. Without treatment, people with BPD have trouble maintaining positive relationships and are vulnerable to abusing drugs and alcohol to cope with difficult emotions.

Where to Find a Support System

Finding the right support system is important when dealing with NPD and AUD. The same applies if you are living with someone who has AUD, NPD, or both.

As Someone Living With NPD and AUD

If you have NPD and AUD, finding support can be challenging because they are two separate disorders with two separate treatment approaches.

You could start by engaging with a mental healthcare provider or treatment center that specializes in dual diagnoses. This ensures that care is coordinated under a central provider. Treatment centers can also ensure that you can access the right support systems at the right time in your treatment.

Alternatively, you can access support symptoms for each condition separately.

This might include joining Alcoholics Anonymous (AA) and other 12-step programs that offer nonjudgmental peer support to others living with AUD. You can also join a local support group offered by the National Association of Mental Illness (NAMI), which addresses substance abuse when NPD and other mental health disorders.

If you live in a remote region, you can also find online support through Facebook Groups or by joining "closed" support groups like I am Sober, Sober Tool, and Sober Grid. You can also access educational and self-help material from organizations like the National Education Alliance for Borderline Personality Disorder (NEABPD).

But don't just limit yourself to support groups. Reach out to loved ones you trust who can walk with you through the recovery journal. They're often the best people to practice disclosure with.

By educating yourself, you can also educate them about what AUD and NPD are about. Allow them to ask as many questions as they need. You can take them with you to your next appointment to talk with your healthcare provider.

By building support from family and friends, you are more likely to stay on course with your dual treatment plan and avoid the stress that can make AUD and NPD worse.

As the Partner, Family, or Friend

If a loved one has NPD and AUD, you may need to find support to help you face the ups and downs associated with the dual diagnosis. Without support, the stress can affect your own mental health and well-being.

You should start by exploring peer support groups like Al-Anon that help families and loved ones living with people with AUD. You can also find narcissist abuse support groups, both online or in-person, through organizations like Help Within Reach. There are numerous other online support groups and chat rooms dedicated to loved ones living with alcoholism and NPD.

You might also consider seeing a therapist who can provide you with coping tools and a means to sort out your feelings. This is especially true if you have conflicted emotions and are reluctant to speak with others who might judge you or your relationship.

If you choose to speak with a friend or family member, be clear about what you need and expect from them, including confidentiality.

If you are being physically or emotionally abused, know that help is available. You can call the National Domestic Violence Hotline at 1-800-799-7233 for advice and referrals to counselors or designated safe houses. They can also help you build a safety plan if you decide that it's time to leave.

If you’re in immediate danger, find a safe location and call 911.

Summary

Narcissistic personality disorder (NPD) and alcohol use disorder (AUD) are closely linked and can occur together as a dual diagnosis. NPD increases the risk of alcohol abuse as a means to escape difficult emotions. While diagnosis and treatment can be challenging, studies have shown that the successful treatment of a mental illness can lead to alcohol recovery in two out of every three cases.