It’s possible to be narcissistic and misuse alcohol. In fact, some research suggests that alcohol misuse might be more common among people who have narcissistic tendencies.
Narcissism and alcohol use can share some signs and symptoms.
Some people who have narcissistic tendencies do misuse alcohol. It’s possible to have a narcissistic personality disorder (NPD) as well as an alcohol use disorder (AUD).
In some cases, someone who’s misusing alcohol may display similar tendencies to narcissistic people — or at least, it might come across that way to those around them.
For example, they might:
- be willing to manipulate or exploit others to maintain their alcohol use
- seem self-absorbed, because they’re focused on alcohol
- seem unempathetic, because they prioritize alcohol use over the needs of others
- be intolerant of criticism, especially when their alcohol use is criticized
- be more arrogant and less self-aware when intoxicated
- have a lack of self-awareness and be unwilling to seek help
- avoid taking responsibility for their actions to avoid shame or guilt
- seem entitled, especially if they use others’ money or resources to maintain their alcohol use
These overlapping traits can make it hard to distinguish alcohol misuse from narcissism.
Not everybody with narcissistic traits or NPD misuses alcohol. In fact, some narcissistic people might not drink at all. Similarly, many people who misuse alcohol might display very few signs of narcissism.
Traits like narcissism and personality disorders like NPD are long-standing. In order to have a diagnosis of NPD, they’ll have to consistently show the relevant symptoms over a period of many years.
Although alcohol misuse and AUD can cause someone to display narcissist-like behavior, this behavior might change when they’re sober or in recovery. The behavior might also only appear when their misuse began.
Before we go further, it’s important to understand the terminology used in this article.
Narcissism vs. narcissistic personality disorder
Narcissism is a personality trait, while narcissistic personality disorder (NPD) is a mental health condition. It’s possible to be somewhat narcissistic without meeting the diagnostic criteria for NPD.
Narcissism is defined as excessive self-love or egocentrism. Someone who’s narcissistic might be self-absorbed and have an inflated sense of self-importance.
However, NPD includes other traits, such as needing constant praise and special treatment, reacting negatively to criticism, and manipulating others. People with NPD might be unwilling or unable to recognize others’ feelings and needs.
Alcohol misuse vs. alcohol use disorder
Many people use the terms “alcohol use disorder” and “alcohol misuse” interchangeably, but they refer to two different things.
Alcohol misuse refers to situations where you drink excessively or when you drink alcohol when it’s harmful – for example, when you’re pregnant or when you have a medical condition that makes alcohol consumption dangerous.
Alcohol use disorder (AUD) is a medical term for alcoholism. If alcohol misuse begins to impact your life, health, or safety, you might have AUD.
In order to get a diagnosis of AUD, you have to fit certain diagnostic criteria as set out in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR).
People can misuse alcohol without having AUD or being addicted to alcohol. They might infrequently have bouts of excessive drinking, for example, but find that it doesn’t affect their life and that it’s easy to cut back on alcohol (or to stop drinking entirely).
It’s worth noting that the DSM-5-TR doesn’t use the term “alcoholism,” but the term is still used colloquially to refer to AUD.
If you think that you or a loved one has NPD or AUD, knowing the symptoms can help you better understand both conditions.
Narcissistic personality disorder
People with NPD might have the following symptoms:
- coming across as boastful or arrogant
- being willing to manipulate or exploit others for personal gain
- feeling entitled to others’ time, resources, and energy
- finding it hard to cope with criticism
- often fantasizing about achieving power and success
- finding it hard to understand or prioritize the feelings and needs of other people
- needing admiration or praise
There are two types of NPD: overt and covert. People with covert narcissism are less likely to come across as narcissists to others, as they have traits not typically associated with NPD. For example, they might be shy.
Alcohol use disorder
People with AUD may experience the following symptoms:
- alcohol cravings
- withdrawal symptoms (like shaking, nausea, and vomiting) when the alcohol wears off
- tremors after drinking
- blacking out after drinking
People with AUD may engage in the following behaviors:
- drinking alone
- becoming defensive when asked about their drinking habits
- not eating or eating poorly
- neglecting personal hygiene
- missing work, school, or other commitments because of drinking
- being unable to control or reduce their alcohol intake
- making excuses to drink
- continuing to drink even when it affects their relationships and commitments
- reducing or giving up activities they typically enjoy because of alcohol use
Overlapping signs and symptoms
People with NPD and people with AUD might have some symptoms in common.
These overlapping signs and symptoms include:
- showing a manipulative or exploitative behavior
- coming across as self-absorbed
- seeming to lack empathy for others
- lacking self-awareness
- exhibiting overentitlement
- being unwilling to seek help
- being intolerant of criticism
Not everybody with AUD or NPD will have all of the above symptoms.
It seems that many people who have NPD might also have AUD, but it’s not clear why. As such, we don’t yet know whether one causes the other.
In other words, those who had narcissistic tendencies were more likely to use alcohol and experience problems because of alcohol use.
Another 2018 study noted that, although we need more research to understand the link between personality disorders and AUD, mental health professionals who are treating people with personality disorders should screen for AUD, and AUD services should screen for personality disorders.
Narcissistic personality disorder
It’s not entirely clear what causes NPD. However,
Parenting types can also contribute to the development of NPD. According to
- experienced childhood abuse or neglect
- had parents who pampered you in excess
- had parents who overpraised you
- had parents who were too lenient
Research on the causes of NPD is ongoing.
Alcohol use disorder
It’s not clear why some people develop AUD while others don’t.
Research suggests that genes may play a role in how your body responds to alcohol, making it either a pleasant or unpleasant experience for you.
People who are genetically predisposed to experience unpleasant side effects of drinking are less likely to drink often, making AUD unlikely.
However, other factors are also at play. You may also be at a greater risk for developing AUD if you:
- live in a family or culture where alcohol use is common and accepted
- have a close relative with AUD
- experience high levels of stress
- have a mental health condition
trauma as a child
Further research into the causes of AUD might help experts develop more treatment options.
Overlapping causes and risk factors
In both NPD and AUD, childhood trauma — including abuse and neglect — may be a risk factor.
Genetics also seem to play a role in the development of both conditions.
Both AUD and NPD should be diagnosed by a healthcare professional. In the United States, the DSM-5-TR is used to diagnose both conditions.
Narcissistic personality disorder
To meet the DSM-5-TR diagnostic criteria for NPD, someone must display at least five of the following traits:
- an inflated sense of self-importance and entitlement
- needing constant admiration and praise
- expecting special treatment as they perceive themself to be superior
- exaggerating their achievements and talents
- reacting negatively to criticism
- being preoccupied with fantasies about power, success, and beauty
- manipulating or exploiting others
- being unable or unwilling to recognize the needs and feelings of other people
- exhibiting arrogance
As with all personality disorders, NPD is a long-standing condition. In order to receive a diagnosis of NPD, someone needs to display the above symptoms over several years. NPD often emerges in childhood.
Alcohol use disorder
According to the DSM-5, you may have AUD if you’ve experienced at least two of the following in the past year:
- You ended up drinking more, or longer than you intended on some occasions.
- You couldn’t cut down on alcohol or stop drinking although you wanted to.
- You spent a lot of time drinking or being sick from drinking.
- Your desire for alcohol was persistent and distracting so that you couldn’t focus on anything else.
- Drinking or hangovers often interfered with your work, familial, home, or school responsibilities.
- Drinking has negatively affected your relationships.
- You’ve given up or cut back on activities that were important to you in order to drink.
- You’ve engaged in dangerous behavior while drunk (such as driving, using machinery, or having sex without a barrier method).
- You’ve continued to drink even when it caused depression, anxiety, health concerns, or blackouts.
- You’ve needed to drink more in order to get the same effect you’ve had in the past.
- You experienced withdrawal symptoms when alcohol wore off, such as insomnia, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure.
A clinician may diagnose mild, moderate, or severe AUD depending on how many criteria you match:
- Mild AUD: You match two to three criteria.
- Moderate AUD: You match four to five criteria.
- Severe AUD: You match six or more criteria.
Overlapping tools for diagnosis
Both NPD and AUD can be diagnosed by healthcare professionals. If you think you have either or both conditions, it’s best to talk with a mental health professional for a diagnosis.
Because alcohol misuse is prevalent among people with personality disorders, and vice versa, researchers suggest screening people in AUD treatment for personality disorders, and screening people in personality disorder treatment for AUD.
Questions to ask yourself
If you think you’re misusing alcohol, or if you think you have NPD, reach out to a mental health professional. Everybody can benefit from speaking with a therapist, regardless of whether they fit the criteria for a mental health condition.
Online self-tests for narcissism aren’t a replacement for mental healthcare. However, you might find it insightful to ask yourself the following questions:
- Do others perceive me as boastful or arrogant?
- Do I find it hard to care about or prioritize the feelings of others?
- Do I find it difficult to take criticism, even when it’s meant kindly?
- Have my relationships been impacted by my sense of entitlement or lack of empathy (whether real or perceived)?
- Is it difficult for me to maintain meaningful, healthy, close relationships?
- Do I often manipulate or exploit others?
Likewise, an online test can’t help diagnose AUD. But you might benefit from asking yourself:
- Do I find myself drinking even when I told myself I wouldn’t?
- Does my drinking affect my relationships, home commitments, finances, or career?
- Has my tolerance to alcohol increased?
- Have I stopped or cut back on enjoyable activities in order to drink?
- Do I engage in harmful or dangerous behavior when drinking or hungover?
- Is drinking affecting my health?
- Have I experienced withdrawal symptoms from alcohol?
If you answered “yes” to most of the questions above, speaking with a therapist might be a good idea. Regardless, it’s always a good idea to look for mental health help if you’re experiencing something that causes you distress.
Both AUD and NPD are treatable. It’s possible for people with AUD to successfully stop using alcohol when they have the right support and treatment.
People with AUD or NPD might resist getting treatment or looking for help. This is a common symptom of both conditions.
People with NPD tend to have difficulty receiving criticism from others, and as such, they might find it difficult to commit to psychotherapy and lifestyle changes.
To get started, contact a doctor or other healthcare professional, or reach out to a therapist.
Narcissistic personality disorder
The main treatment for NPD is talk therapy, also known as psychotherapy.
There are no medications to treat NPD, but if you also experience depression or another mental health condition, a doctor may prescribe medications to treat the other condition.
Different types of therapy can be used for NPD, including:
- cognitive behavioral therapy (CBT)
- dialectical behavioral therapy (DBT)
- EMDR therapy (which is typically used for trauma)
- transference-focused psychotherapy (TFP)
Therapy can help you:
- identify existing defense mechanisms
- explore past traumas and their effect on your current behavior
- explore how your behavior affects others
- examine patterns of behavior and thinking
- learn and practice new patterns of behavior
- learn to cope with shame and vulnerability
You might also engage in lifestyle changes and self-care strategies in order to make progress. One such change might be to avoid substances like alcohol if they tend to trigger harmful behavior.
Alcohol use disorder
There are several treatments for AUD. Treatments can occur in different stages. Each person needs a different treatment method depending on their unique situation, and as such, not everyone will have the same treatment program.
You might go through:
- initial detoxification or withdrawal to rid your body of alcohol
- rehabilitation to learn new coping skills and behaviors
- counseling or talk therapy to address emotional problems and stressors
- support groups, including 12-step programs
- medical treatment for any health problems caused by alcohol use
- medications to help control addiction
If your alcohol use is severe, you’ll likely need to go to an inpatient facility so that you can safely withdraw from alcohol. Alcohol withdrawal can be dangerous, so it’s important to seek medical help.
After the withdrawal stage, you could seek inpatient or outpatient care depending on your needs and the services offered by the facilities that are available to you.
Overlapping treatment options
Talk therapy can be a helpful treatment for both NPD and AUD. With both conditions, the benefits of therapy depend on your willingness to work on yourself. You get out what you put in.
Although NPD can’t be cured, someone with NPD can change their behavior if they’re willing to put in the time and effort, according to
Likewise, people with AUD can successfully recover from the disorder. Therapy, a strong support system, and self-care strategies can help you make a full recovery.
Relapse is a common experience among people who are recovering from AUD. You can take steps to prevent relapse, such as recognizing your triggers and joining a support group. If you do relapse, try to seek help again — it’s still possible to make a full recovery.
There’s little data on whether people with both NPD and AUD have a different outlook than people who have only one of the conditions. However, it’s recommended that both conditions are treated at the same time to improve your likelihood of recovery.
If you think you have AUD, you can try the following resources:
If you think you have NPD, try to make an appointment with a mental health professional. You can connect with a mental health professional using the Healthline FindCare tool.
Support from loved ones can help people with NPD or AUD change their behavior and work toward recovery.
While it’s a good idea to try to help someone with AUD or NPD, remember that the change needs to come from them, not you: You can’t do the work for them.
- Gently encourage them to seek help in the form of therapy, support groups, or rehabilitation. Helping them identify a therapist or rehab can be a great first start.
- Take care of yourself and set boundaries. Enabling their behavior only makes it easier for the behavior to continue.
- Find your own sources of support. Join support groups, such as Al-Anon Family or Adult Children of Alcoholics.
People with NPD may be more likely to misuse alcohol and develop AUD. Also, people with AUD might seem to behave similarly to people with narcissistic traits.
Both conditions can be treated. If someone has AUD as well as a personality disorder, it’s recommended that both are treated at the same time to improve their chances of recovery.
Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.