Exploring the Connection: Narcissism and Alcoholism

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Many people struggling with substance misuse have co-occurring mental health disorders. Narcissistic personality disorder (NPD) and alcohol use disorder (AUD) share unique risk factors and often overlap with other conditions. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in 2021, "29.5 million people ages 12 and older (10.6% in this age group) had AUD." Individuals with NPD have a higher risk of developing AUD. Pathways Recovery Center uses evidence-based treatments to help clients with narcissism and alcoholism. 

Individuals diagnosed with clinical narcissism are more likely to misuse drugs, alcohol, and prescription medications. In addition, people with NPD have a higher risk of being diagnosed with more severe mental health disorders, including schizophrenia. NPD is rarely the only diagnosis. Integrative care is essential to ensure clients with narcissism and alcoholism have the guidance to manage their co-occurring mental health disorders. 

Chronic alcohol misuse changes neurotransmitters in the brain and affects how the body responds to alcohol. AUD is a leading cause of mental and physical illness. According to BioScience Trends, "Alcoholism is a global socially significant problem and still remains one of the leading causes of disability and premature death. One of the main signs of the disease is the loss of cognitive control over the amount of alcohol consumed." An inability to control impulsive behaviors is common among narcissistic individuals, making it more challenging to diagnose alcohol dependence and AUD. The risk factors, symptoms, and side effects of NPD and AUD are interlinked and feed off one another. 

Understanding Narcissism and Alcoholism

The connection between narcissism and alcoholism is not always obvious. Many people with narcissistic behaviors are highly controlling of their environment and health. However, in some cases, alcohol addiction develops from social drinking or as a form of self-medication. People with narcissism may have difficulty recognizing or accepting when they lose control of their drinking. Learning about clinical narcissism and alcoholism independently makes it easier to understand their connections and how the conditions may influence one another. 


Clinical narcissism is named after Narcissus from Greek mythology. In the legends, Narcissus, the son of a god, fell in love with his own reflection and died pining for the "perfection" he saw within that reflection. Everyone experiences periods of narcissism. Generally, people grow out of overt narcissistic behaviors when they reach puberty. However, narcissistic traits do not inherently indicate the presence of a mental health disorder. Narcissism has positive attributes, including increased self-confidence and self-sufficiency. However, narcissism becomes an issue when it negatively affects aspects of a person's life and relationships.

Clinical narcissists are obsessed with themselves to the point of not being able to form healthy relationships. According to the journalTextual Practice, "The term narcissism was coined in 1899 by Paul Näcke, who used it to describe a subject who treats himself like a sexual object." Narcissistic personalities may also use relationships with family and others to expand their self-love. "Object love" is one way to describe relationships narcissists have with others. Instead of genuinely valuing others, they see friends and loved ones as objects through which they experience various aspects of self-love. Individuals with these types of relationships may not consider how their actions affect others. 

Anyone can develop NPD. However, some people have a higher risk. According to the Journal of Clinical Psychology, "Prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than women (4.8%)." In addition, "NPD was significantly more prevalent among Black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults."

Some signs and symptoms of clinical narcissism include: 

  • Entitlement 
  • Inability to cope with any form of criticism 
  • Selfish behaviors and a disregard for the needs of others 
  • A constant need for validation and admiration 
  • Grandiosity 
  • Inability or unwillingness to empathize with others 
  • Social isolation
  • Unfeeling or unemotional behaviors 
  • Obsession with being beautiful, powerful, and influential 
  • Arrogance
  • Purposefully only spending time with people who are powerful or influential
  • Frequently exploiting others for personal gain 

Individuals with NPD may do whatever it takes to achieve power, beauty, and admiration, even if it causes great harm, like Narcissus in the Greek tragedy. Risk-taking behaviors, including alcohol and drug abuse, are common in individuals with NPD. 

Researchers have reported two types of narcissism. Vulnerable and grandiose narcissism have many similarities. However, they may differ in presentation. According to Frontiers in Psychology, "Vulnerable narcissism is related to withdrawal, low self-esteem, negative affect, sensitivity to negative feedback, and defensiveness. Grandiose narcissism reflects positive self-esteem, inflated self-views, high approach motivation, social confidence, and the need for admiration." Each form of narcissism requires different treatments to address the root causes of the disorder. Pathways Recovery Center uses personalized care plans to ensure each client receives the best treatment for their condition.  

Family involvement in treatment is often difficult for individuals with NPD. However, studies have shown family participation in the treatment process may increase the effectiveness of therapy for some individuals. Narcissism has a profound effect on children and the entire family unit. According to Brain Informatics, "Narcissistic parents project their inflated self-views onto their children, who internalize these experiences in an unconscious manner, resulting in a mimicking behavior." Sometimes, "When children are overvalued or indicated to have superiority over others, they tend to develop narcissism." Parents with NPD help their children avoid falling into the same maladaptive patterns of behavior by participating in family therapy and other family support services. 


Alcohol abuse is a chronic disease with many known risk factors. According to the Department of Veterans Affairs (VA), "On average, two-thirds of individuals treated for alcohol use disorder (AUD) relapse within six months." Chronic relapse is a part of the recovery process for some individuals and a symptom of the disease. Individuals with co-occurring personality disorders have a higher risk of experiencing a relapse during treatment and early recovery. 

Many people drink alcohol socially and are unaware of the dangers and risks. Casual drinking has the potential to cause dependency and addictive behaviors. Binge drinking is one of the most common forms of alcohol misuse. According to the Centers for Disease Control and Prevention (CDC), "Most people who binge drink are not dependent on alcohol." However, binge drinking "is associated with serious injuries and diseases, as well as with a higher risk of alcohol use disorder." 

Alcohol abuse impacts all areas of a person's life, including physical health and relationships. Some of the side effects of chronic alcohol abuse include: 

  • Memory issues
  • Decline in cognitive function
  • Increased risk of heart disease, liver disease, kidney disease, and cancer 
  • Changes to temperament, including unusual aggression and violence 
  • Difficulty focusing or learning new skills 
  • Increased risk of experiencing a severe illness, injury, or accident 

Genetics, environmental factors, age, gender, and family medical history all play a role in whether someone develops a mental health or substance use disorder (SUD). Pathways Recovery Center uses a holistic approach to treatment for individuals with alcoholism and co-occurring NPD.

The Intersection of Narcissism and Alcoholism

Narcissism often hides underlying emotional pain and fear. Alcohol is sometimes used as a maladaptive coping mechanism to help people with NPD manage insecurities and emotional discomfort. In addition, the need to constantly look and act perfect may cause some people with NPD to develop depression, anxiety, or other mental health symptoms. Narcissism and alcoholism both worsen symptoms people may be trying to avoid.

Alcohol is often misused to reduce anxiety, depression, panic, and overwhelming feelings. According to Depression and Anxiety, "The comorbidity of mood and anxiety disorders (MD and AD) with substance use disorders (SUD) is common. One explanation for this comorbidity is the self‐medication hypothesis, which posits that individuals with MD or AD use substances to cope with the difficult symptoms associated with the disorder."

The Narcissist's Relationship With Alcohol

Chronic alcohol misuse worsens symptoms of untreated NPD, enhancing narcissistic personality traits. People with NPD often have poor impulse control and difficulty relating emotionally to others. In addition, they may not be able to identify and process their own emotions in a healthy way. Some people use alcohol to numb overwhelming, confusing, or unwanted feelings. 

Narcissistic individuals who misuse alcohol are more likely to be self-destructive. People with NPD have a higher rate of relationship failures, legal issues, and difficulty making healthy social connections in their personal and professional lives. Sometimes, self-destructive tendencies cause people with NPD to make impulsive life-changing decisions, including cheating on a spouse or failing to follow proper workplace procedures. AUD increases risk-taking and self-destructive behaviors by lowering inhibitions and increasing symptoms of both conditions. 

Impacts and Consequences

Untreated narcissism and alcoholism devastate individuals, families, and communities. The fact that other people bear the brunt of the adverse side effects sets NPD apart from most other disorders. The person with the disorder is often the last to experience consequences as they manipulate others to protect themselves. However, consequences cannot be avoided forever. 

Loss of close relationships is often the most devastating and frequent consequence of untreated NPD. Other consequences include: 

  • Loss of family, friends, and acquaintances
  • Demotion or loss of job
  • Loss of home or social community 

Narcissism and alcoholism feed off one another, and if either is left untreated, the risk of relapse and severe illness or injury increases significantly. Alcohol detox helps clients learn essential social skills and other tools to manage the symptoms of NPD. 

Impact on Self

Co-occurring disorders have a profound impact on individuals and families. Narcissism and alcoholism have a complicated relationship. According to studies, "Substance use disorder is also related to NPD, and when there is an association of substance use disorder with NPD, there is significantly more hostility, and aggression is also present." The changes in temperament and mood increase mental health symptoms and cause relationship issues. 

The physical side effects of untreated co-occurring disorders vary depending on several factors, including: 

  • Age
  • Gender 
  • Genetics 
  • Environment 
  • Family medical history

People recovering from co-occurring AUD and NPD must find healthy ways to replace maladaptive behaviors and thought patterns. Narcissism involves manipulation, taking advantage of the kindness of others, and selfish behaviors. The care team helps clients overcome these symptoms and develop a healthy support system. 

Impact on Relationships

Family and friends of individuals with co-occurring AUD and NPD may feel overwhelmed or unable to help. Narcissists manipulate others to achieve their own interests, and any attempt at an intervention may cause them to strike out physically or emotionally. Relationships with a narcissist often end in heartbreak. Many individuals with NPD end up divorced or separated from their partner. Other close relationships suffer from the effects of narcissism as well. Often, loved ones feel helpless. Pathways Recovery Center helps families and friends stage effective interventions for loved ones struggling with AUD and NPD. 

Overcoming the Dual Challenge: Treatment and Recovery

Early intervention and treatment are the best ways to ensure a person avoids the severe side effects of narcissism and alcoholism. Dual-diagnosis treatment focuses on providing clients with emotional stabilization and ensures they receive support for any underlying issues affecting their mental or physical health. 

Therapy is one of the most effective forms of treatment for clients with NPD and co-occurring AUD. Pathways Recovery Center's residential dual-diagnosis treatment provides clients the support they need to grow, heal, and thrive. Many forms of therapy help treat both NPD and AUD. 

The care team at Pathways Recovery Center addresses narcissism and alcoholism concurrently through the following services: 

  • Al-Anon and Narc-Anon support 
  • Individual psychotherapy
  • Group counseling
  • Prescription medication
  • Alternative holistic therapies

Clinicians work together to ensure all departments provide cohesive and consistent treatment for clients struggling with their surroundings. Integrative treatment reduces the risk of additional disorders. 

Preventive Measures and Healthy Coping Strategies

Alcohol misuse is often a form of self-medication for individuals with co-occurring mental health issues. Relapse prevention education and developing essential coping skills during treatment provide clients with healthy ways to manage their disorders long-term.  

A few practical changes people in recovery make to reduce the risk of developing severe or long-lasting side effects of AUD include: 

  • Reducing alcohol consumption or abstaining entirely
  • Setting clear and healthy boundaries
  • Developing essential social skills, including conflict resolution, empathy, and effective communication 

Setting boundaries and respecting the boundaries of others is a cornerstone of long-term recovery for clients with access to residential treatment. Clients learn to trust peers and their clinical team. Setting healthy boundaries by engaging in positive social situations reduces the risk of relapse. Engaging in positive social engagements is considered a form of self-care. 

Alcoholism Treatment - Pathways Recovery Center in Azusa, CA

The path forward involves fully understanding the risk factors, underlying issues, and side effects of co-occurring NPD and AUD. Pathways Recovery Center offers detox and residential treatment programs. Comprehensive admissions assessments and testing, including a biopsychosocial assessment, ensure clients receive the best treatments and have the information they need to make informed decisions about their health. Families may also participate in treatment. 

NPD and AUD are brain diseases, and evidence-based integrative care ensures clients have the skills to manage their recovery effectively. Some of the services and therapies offered at Pathways Recovery Center include: 

  • Alcohol and drug detox 
  • Residential treatment (RTC) 
  • Case management 
  • Cognitive-behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • 12-Step support
  • Alumni services 
  • Alternative holistic therapies

Individuals and families affected by NPD and AUD benefit from attending family therapy and support groups. Some studies have shown people diagnosed with NPD respond more positively to therapeutic and social interventions. According to Frontiers in Psychology, "During couple consultations couples with narcissistic spouses often report basic communication problems and, accordingly, a significant level of stress." Family therapy reduces tension within family units by increasing positive communication between couples, children, and other family members. Often, family therapy reduces the negative effects on children or partners. Pathways Recovery Center uses evidence-based therapy and personalized treatment plans to support clients with co-occurring NPD and AUD. 

Co-occurring NPD and AUD are challenging to treat. The two disorders have many overlapping risks. In addition, the symptoms of both disorders worsen each other unless the person participates in treatment. Residential and detox programs help individuals and families recover successfully from both disorders. The care team at Pathways Recovery Center guides clients through the transition between levels of care. During early recovery, individuals with NPR and AUD often have difficulty maintaining healthy social relationships. Treatment prepares clients for long-term sobriety by ensuring they have the skills and tools to establish and maintain healthy relationships. To learn more about the programs at Pathways Recovery Center, call our office today at (888) 771-0966.

Clinically reviewed by 

Moses Nasser
Dr. Moses Nasser, a double board-certified physician in Family Medicine and Addiction Medicine, with expertise in holistic healing, addiction medicine, and psychiatric care, holds an X-waiver to prescribe buprenorphine and has extensive experience in mindfulness-based customer service and medication-assisted treatment.

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