The Link Between Narcissistic Personality Disorder and Alcoholism

Narcissism is a personality trait that in some people can be part of narcissistic personality disorder (NPD) and alcoholism is a substance use disorder, but the two are linked and share similar qualities. Narcissists can become alcoholics and alcoholics can be particularly narcissistic when drunk. Many alcoholics are not narcissists when they’re sober. 

This article discusses the similarities and differences between people with narcissistic personality disorder and people with alcohol use disorder and where and when they overlap. It also discusses the various treatments available for people experiencing these disorders.

What Is Alcohol Use Disorder?

Alcohol use disorder (AUD) is the medical term for alcohol abuse or alcoholism. It refers to the inability to control alcohol intake despite negative social, health, financial, or other impacts and growing dependence and tolerance (i.e., when you need more of the same drug to have the same effects because your body is used to it). It also refers to when your body goes into withdrawal without alcohol.

One in 10 children live in a home with a parent who has a drinking problem.

Handsome bearded man with a glass of whiskey

urbazon / Getty Images

Narcissists vs. Alcoholics 

Narcissists or people with narcissistic personality disorder may use alcohol to help them cope with aspects of their disorder. Alcoholism or alcohol use disorder may trigger someone to develop narcissistic traits.

What Is the "Narcissist Alcoholic?"

The narcissist alcoholic or alcoholic with narcissist traits has co-occurring narcissist tendencies (or narcissistic personality disorder) and AUD.

It’s not known for certain how likely someone is to experience both clinical disorders, but a 2018 meta-analysis of 16 studies found lifetime prevalence for alcohol use disorder and personality disorders is estimated at 38.9% (excluding antisocial personality disorder and borderline personality disorder, which have even higher estimated rates).

Overlapping Traits

Narcissists and alcoholics share various traits. Both may:

  • Be self-absorbed: The addiction to alcohol narrows their perspective until it’s all about them getting alcohol, consuming alcohol, paying for alcohol, etc.
  • Have an exaggerated sense of entitlement: This may be to alcohol, to other people’s alcohol or personal belongings including their time, home, and money.
  • A lack of empathy for others: This is due to being all-consumed in the addiction
  • Show no shame in manipulating others to get what they want

Overt narcissists or classic narcissists have a larger-than-life (grandiose) view of themselves. They often have difficulties with self-awareness and recognizing when they need help. They are typically vain and self-serving. Overt narcissists are also interpersonal exploiters—people who use relationships as a way of getting what they want. 

People with AUD can also be self-serving, experience grandiose thinking, and have trouble recognizing when it’s time to seek help. They are also known to engage in exploitative or manipulative behaviors as a way of maintaining their addiction. 

Difficulty With Diagnosis

The shared denial, lack of self-awareness, and refusal to take responsibility for one’s actions can make the diagnostic process particularly challenging. It can also mean one disorder (or both) may go undiagnosed.

Researchers have suggested that due to the link between personality disorders (PD) and AUD, it’s important for healthcare providers to screen for both disorders when one is present.

Overlapping Signs and Symptoms

Overlapping signs, symptoms, and behaviors may include:

  • Neverending or insatiable need for drug of choice: attention or alcohol
  • Exaggerated sense of importance
  • Avoiding certain emotions like shame or guilt
  • Blaming others or shifting responsibility to someone else
  • Destructive (to self and others)
  • Mood swings
  • Ongoing relationship troubles (breakups, makeups, empty or unfulfilled promises)

Does One Cause the Other? 

The relationship between NPD and AUD is far too complex to say that either one “causes” the other. People with personality disorders have difficulties coping with daily stressors and may turn to alcohol to escape their feelings.

The link between mental health conditions and substance misuse is strong; several national surveys have found that around half the population with a mental illness or substance use disorder will experience the other.

Personality plays a role, too, even in the absence of a clinical personality disorder. Personality is a contributing factor to whether or not someone is likely to develop an alcohol use disorder.

A 2019 study of 345 college students (28% male, 72% female) found both grandiose (overt) and vulnerable (covert) forms of narcissism to be good predictors of alcohol use and alcohol-related problems. Overt narcissism is the stereotypically overly confident, vain, and arrogant type of narcissism. Covert narcissism is the introverted, victim-role for attention, self-doubting type of narcissism.

There may also be common environmental contributing factors for NPD and AUD. Factors include:

  • Experiencing trauma in childhood, such as sexual, physical, or emotional abuse or neglect
  • Living in a home with a person with alcohol use disorder or other addiction
  • Living with someone with any mental illness, including NPD

Being a Narcissist When Drunk 

Exhibiting narcissistic behavior when drunk doesn’t necessarily mean a person has narcissistic personality disorder. Alcohol can influence narcissistic attitudes, including arrogance, self-importance, and an inflated self-esteem or feelings of superiority that aren’t otherwise present when sober.

Narcissism looks like the drunk person monopolizing all conversations, exaggerating their stories to sound better and gain admiration, and making poor choices such as lying, manipulating, or cheating in order to get their way at any cost.

Over-Consumption Is Dangerous

The self-destructiveness associated with both NPD and AUD makes continuing to drink to the point of getting drunk incredibly risky. When drunk, inhibitions are lowered and self-awareness is even further compromised, leaving the drunk narcissist vulnerable to making dangerous decisions like drinking and driving or over-consuming and experiencing alcohol poisoning.

According to the World Health Organization, 3 million deaths occur every year worldwide due to harmful use of alcohol, representing 5.3% of all deaths.

Initiating Treatment 

If you or someone you care about is struggling with AUD and NPD, please consider starting the conversation about treatment. While it may seem daunting, these two conditions are best tackled together. AUD is progressive, meaning it will only get worse over time without treatment. AUD can also be fatal (e.g., increased risk of accidents, suicidal behavior, assault, and physical effects of excessive alcohol consumption and withdrawal). 

Contact your healthcare provider, find a therapist, or check out Alcoholics Anonymous (AA). AA offers free online meetings at any hour of any day.

Suicide Prevention Hotline

If you or someone you know are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger or concerned for someone’s safety, call 9-1-1.

Relapse and Recovery 

Relapse, or a return to drinking, can be extremely challenging for the person with NPD and AUD and those that love them. Narcissists, by definition, have trouble accepting criticism and admitting when they’re wrong. Narcissists may hide, deny, or downplay if they start drinking again, especially since they may have made their sobriety the new focus of attention in your family or friend group. 

Relapse is common in people with AUD, but many do recover. Seeking professional help early on can help prevent relapse to drinking. Treating both conditions at the same time is also advised as a means of reducing relapse risk.

Where to Find a Support System 

Finding the right support system is important when dealing with co-occurring disorders or helping someone who has NPD, AUD, or both. 

Substance Use and Mental Health Helpline

If you or a loved one are struggling with substance use, addiction, or NPD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

As the Patient

To get the support you deserve, you’re going to need to seek professional help. Admitting there’s a need for help is the first hurdle. Finding the appropriate mental health and addiction professionals is the next hurdle.

Change is possible with help. You can find support by speaking with your healthcare provider about what you’re noticing or what others have told you. For example, maybe you’re considering seeing a healthcare provider because your spouse says you’re a narcissist who drinks too much and they won’t stop asking you to get help. It may be a good idea to slow down and, keeping in mind no one is perfect, really listen to what your spouse is saying and how your healthcare provider responds.

If you’re not quite ready to talk to someone about narcissism or alcohol use, and if you’re wondering if your relationship to alcohol is healthy, there are many online assessments you can take to let you know where you sit on the spectrum of narcissistic traits and drinking behaviors. These are not diagnostic tools, but can be helpful to give you an idea so you can have an honest conversation with yourself and, when ready, your healthcare providers.

AA and other 12-step programs can also provide a valuable added layer of peer support for people quitting or cutting back on their drinking. Exact outcome data is hard to determine due to the anonymity of the programs.

Online “closed groups” and public groups, as well as apps that track usage or money saved and health benefits since quitting, like I am Sober, Sober Tool, and Sober Grid, are also useful to people seeking more support or reward replacements.

Other Resources

As the Partner 

If you’re the partner of someone with NPD and AUD, you likely witness and hear things the narcissist’s family and friends don’t. Understandably, this can make it difficult to seek support from them or to convince them of a need for intervention. Your partner may also have surrounded themselves with people who feed their narcissism with praise, admiration, and constant validation (people pleasers).

Self-Care for Partners

Whether you decide to stay in the relationship or leave but are involved through shared children, getting support for yourself is essential. Being with a narcissist is emotionally exhausting and may leave you drained and feeling like you’re walking on eggshells.

Seeking outside support from your social network or professionals can help you manage these feelings.

You may want to begin with peer support groups for family members of alcoholics (Al-anon) and/or support groups for people in a relationship with a narcissist or narcissist abuse support groups. These groups are offered in-person and online.

If you are being physically, emotionally, or sexually abused, know that there is help available. Take a moment in a safe location like a public washroom to create a plan for safety at the Domestic Violence Hotline so you’re prepared if or when you decide to leave. If you’re in immediate danger, please dial 9-1-1. 

Summary

NPD is a personality disorder and AUD is an addiction. While different, they can co-occur and they share similarities. People with NPD and AUD may avoid taking responsibility, have a lack of self-awareness, live with grandiosity, and may be practiced in manipulating others to get their own way.

Treatment is best approached as a team effort to cope with both disorders. Relapse can occur, but doesn’t mean hope for change is lost.

A Word From Verywell 

Although you may be convinced you’re dealing with a narcissist and that they have an alcohol use disorder, only a qualified healthcare provider can make a formal diagnosis. Beyond that, only the person with narcissism or with an alcohol use disorder (or both) can do the work involved in changing their narcissistic thought patterns and drinking behaviors. You can help by seeking support for yourself and knowing when it’s time to enforce more boundaries or leave.

Frequently Asked Questions

  • Is it safe to drink if you have been diagnosed with a narcissistic personality disorder?

    Drinking when you have been diagnosed with narcissistic personality disorder can be additionally dangerous. Drinking alcohol lowers inhibitions and can increase other narcissist behaviors including self-absorption, denial, illusions of grandeur, and destructiveness. These behaviors can lead to poor choices, including drinking and driving or excessive consumption, which can be fatal.

  • How do you know if your partner is an alcoholic narcissist?

    There are diagnostic criteria you can check within the DSM to see how many signs of alcoholism or narcissism apply to your partner. You may have some idea that you’re dealing with an alcoholic narcissist, but the two conditions are complex and can only be diagnosed by a medical professional.

  • How likely are you to abuse alcohol if you have NPD?

    People with NPD may abuse alcohol in an attempt to cope with the impact of their disorder. About half of those with a mental illness will experience a substance use disorder at some point in their lives, and vice versa, according to several national surveys.

  • Do alcoholic narcissists ever truly change?

    Alcoholic narcissists can change, but it does require a few hurdles like admitting there is a problem and need for change and following through with treatment plans. Only the alcoholic narcissist can decide if they need help and when they’re ready to begin treatment.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. MedlinePlus. Personality disorders.

  5. The National Institute on Drug Abuse. Common comorbidities with substance use disorders research report part 1: the connection between substance use disorders and mental illness.

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By Michelle Pugle
Michelle Pugle, BA, MA, is an expert health writer with nearly a decade of contributing accurate and accessible health news and information to authority websites and print magazines. Her work focuses on lifestyle management, chronic illness, and mental health. Michelle is the author of Ana, Mia & Me: A Memoir From an Anorexic Teen Mind.