Narcissism and alcoholism are different conditions, but they can occur simultaneously and may share some overlapping symptoms. While both conditions can be challenging, certain approaches can help individuals overcome the potential complications of these disorders.

Narcissism is a personality disorder that may cause individuals to display grandiose and self-involved behaviors. Alcoholism is an addiction where people cannot control their alcohol use. Narcissism and alcoholism may both share similar characteristics and can occur at the same time. Recognizing these links traits may enable individuals to seek appropriate help in managing these conditions.

In this article, we look at the similarities and differences between narcissism and alcoholism, their diagnosis criteria, and treatment options for each condition.

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Narcissism is a personality trait where people may feel a need for admiration, show a lack of empathy, or be self-involved. It is typical for people to display occasional narcissistic traits, but a pattern of narcissism could be part of narcissistic personality disorder (NPD), a mental health condition.

Alcoholism, or alcohol use disorder (AUD), is an addictive disorder where people cannot control or stop their use of alcohol. People with AUD may be unable to reduce or stop drinking despite experiencing the negative effects of alcohol or a desire to quit.

Both conditions may influence the other, and some symptoms or behaviors of each condition can overlap.

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People with narcissism or NPD may display the following behaviors:

  • grandiosity
  • a need for admiration
  • lack of empathy
  • aggression
  • decreased tolerance to distress
  • difficulty in maintaining relationships
  • overly emotional or unpredictable behavior
  • feeling unique or special compared with others
  • selfishness
  • focused on achievement

Two types of narcissism include grandiose and vulnerable narcissism. Grandiose narcissists may:

  • have high self-esteem
  • show dominance in relationships or communication with others
  • overestimate their abilities

Vulnerable narcissists may:

  • be defensive
  • avoidant
  • be hypersensitive in relationships or communication with others

Symptoms and behaviors of AUD may include:

  • drinking more alcohol than a person originally intends
  • being unable to reduce or stop drinking alcohol
  • only being able to think of alcohol and how to get the next drink
  • drinking alcohol in a way that interferes with home life, work, studies, or relationships
  • replacing hobbies or enjoyable activities with alcohol
  • a person finding themselves in dangerous situations as a result of drinking alcohol
  • withdrawal symptoms once the alcohol wears off, such as shaking, nausea, or difficulty sleeping

It is common for personality disorders to occur alongside AUD. According to the National Institute of Mental Health, 22.6% of people with a personality disorder may also have a substance misuse disorder.

A 2019 study looked at the link between narcissism and alcohol consumption in a questionnaire of 345 college students. Both grandiose and vulnerable narcissism were predictors of alcohol consumption and alcohol-related problems.

The study commented that people who show grandiose traits may have feelings of importance in an environment of drinking where this quality may thrive. Narcissists with low self-esteem may gain acceptance from others or a sense of security through alcohol consumption or use it as a coping mechanism for dealing with distress.

When people have a mental health condition that co-occurs with a substance misuse disorder, such as AUD, doctors may refer to this as dual diagnosis.

According to a 2018 article, due to the common co-occurrence of personality disorders and AUD, it is important that substance misuse services screen for personality disorders and vice versa.

Features of AUD and NPD that may overlap may include:

  • a persistent need for certain external factors, either attention or alcohol
  • avoidant behavior, such as avoiding emotions such as shame or guilt, or shifting responsibility
  • blaming others
  • destructive, either to themselves or others
  • mood swings or unpredictable behavior
  • difficulties with work or relationships

NPD is a personality disorder, whereas AUD is a substance use disorder.

With AUD, a person’s behavior may change depending on whether they are sober or not. An individual with NPD will display a consistent pattern of narcissistic behavior.

People with AUD may have self-awareness of their condition and a desire to change. However, some with NPD may not be aware of how their behavior affects others.

To treat dual diagnosis, people will receive treatment options for both NPD and AUD. Individuals can discuss how NPD and AUD can affect the other with their doctor.

Treatment for AUD will vary for each individual but may include:

  • Detoxification: People will need to detox from alcohol to get the substance out of their system. This process may require 24/7 monitoring over the course of a week to manage the effects of withdrawal.
  • Rehabilitation: People may need to stay in a rehabilitation center to receive mental health care, medication, therapy, and support to treat the underlying causes of AUD.
  • Psychotherapy: Cognitive behavioral therapy (CBT) may help people with dual diagnosis learn healthy coping strategies and change thinking patterns to overcome substance misuse.
  • Medications: Certain medications may help treat mental illness or ease withdrawal symptoms from substance misuse.
  • Support groups: Support groups can help people feel less isolated during their recovery and connect with others going through similar experiences.

Treatment for NPD is usually a long-term process that may involve therapies such as:

  • psychodynamic therapy
  • CBT
  • schema therapy
  • relationship therapy

Healthcare professionals and psychologists may use a set of criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose narcissism or AUD.

Healthcare professionals may ask people about their drinking habits to assess AUD. To diagnose NPD, a doctor may refer people to a psychiatrist. A psychiatrist may carry out a standard psychiatric interview, which healthcare professionals use to diagnose personality disorders. Healthcare professionals may also use the Narcissistic Personality Inventory to diagnose narcissism.

The outlook of co-occurring NPD and AUD may depend on the severity of each condition and how each individual is functioning.

People may be unable to prevent certain factors, such as genetic reasons, that increase the risk of AUD and NPD. However, there are steps they can take to reduce risks within their control.

Risk factors for AUD may include:

  • drinking at an early age, rather than waiting until the age of 21 or older before drinking
  • alcohol misuse, such as excessive drinking or heavy alcohol consumption
  • a family history of alcohol problems
  • mental health conditions or trauma, including depression, post-traumatic stress disorder, and childhood trauma

If people have risk factors for AUD, feel they are drinking excessively, or cannot control their alcohol intake, they can speak with a healthcare professional.

Following alcohol guidelines can help people stay within moderate levels of alcohol consumption. For females, it is not advisable to consume more than one unit of alcohol per day. For males, the guidelines advise no more than two units per day.

Risk factors for NPD include having difficult relationships with parents or caregivers during a person’s developmental years that may include excessive praise or criticism. Childhood trauma or abuse can also be factors.

Although it may be impossible to prevent NPD, people can take steps to reduce the risk of developing additional disorders through the understanding that it is common for substance misuse disorders to co-occur.

Although people with AUD may relapse or have treatment setbacks, they can recover from the disorder. Learning healthy coping strategies can help them remain sober when they face triggers.

Treating NPD can be challenging and may require long-term therapy, but working alongside healthcare professionals can help people reduce symptoms. With treatment, those with NPD can live healthy lives with positive relationships.

Similarly, people with dual diagnosis can manage their symptoms with appropriate treatment.