The Relationship Between Narcissistic Personality Disorder and Substance Abuse

man staring into camera covering his mouth

Narcissistic personality disorder (NPD) and substance abuse often go hand-in-hand. This is because individuals with NPD typically seek out ways to escape their overwhelming emotional anxiety and pain. In a similar fashion, individuals with substance use disorder sometimes display narcissistic traits. To continue, individuals with narcissism may struggle from feelings of isolation that cause a compulsion to self-medicate with substances. Individuals with NPD may be distrustful of, insecure about, or feel superior to those around them – causing them to be unable to connect with their peers. Thus, causing feelings of isolation and loneliness.

When an individual suffers from a narcissistic personality disorder and substance abuse issues, this is known as dual-diagnosis. By definition, a dual-diagnosis refers to an individual who has a mental health condition as well as a substance use disorder. Unfortunately, co-occurring disorders are extremely common, especially narcissistic personality disorder and substance abuse in particular.

Individuals suffering from both conditions must receive treatment for their NPD and addiction simultaneously. When individuals do not recover from both ailments, one disorder can trigger a relapse in the other. Therefore, if you or a loved one are displaying signs of a substance abuse disorder, NPD, or any other mental condition, it is vital that you seek professional dual-diagnosis treatment.

What is Narcissistic Personality Disorder (NPD)?

Individuals with narcissistic personalities tend to seek admiration from others while ensuring to maintain an emotional distance from them. If someone with NPD begins to feel threatened or as if someone is getting too close to them, their narcissistic behavior will intensify. Oftentimes, this behavior either irritates or offends the individual, creating the space the person of concern desired. Additionally, a narcissist will often blame others for their anger, allowing them to disregard reality and preserve their elevated sense of self.

Individuals suffering from narcissistic personality disorder tend to be:

  • Boastful
  • Pretentious
  • Emotionally distant
  • Jealous
  • Devaluating of other people

Oftentimes, individuals suffering from this disorder tend to display problematic and maladaptive behaviors that can cause significant damage to their lives.

How are Narcissistic Personality Disorder and Substance Abuse Connected?

One of the most obvious similarities between NPD and substance use disorder is that in both disorders, individuals seek out external ways to fill a void of emptiness. The narcissistic relies on the admiration and attention of other people, real or imagined. Additionally, narcissists will create situations of accomplishments in order to obtain praise, make others envious of them, or act in attention-seeking behaviors. This is accomplished in a similar manner as the way an individual with substance use disorder will ensure their drug supply is constant and secure.

Individuals with a narcissistic personality disorder will put all of their time and effort into keeping up appearances and receiving praise in order to fill their void. However, the attention and admiration that they require will increase over time. Similarly, individuals with substance use disorder will have to increase dosages over time in order to produce the same desired effect. When individuals with either disorder feel as if they are not receiving an adequate amount of attention or substances (drugs or alcohol), they will experience anxiety, depression, and other adverse psychological effects.

Other common overlapping characteristics between narcissism and substance abuse include:

  • Self-medication
  • Emotional avoidance
  • Shame
  • Denial
  • Minimizing
  • Normalizing
  • Blaming
  • Low self-esteem
  • Controlling behavior/manipulation
  • Codependency
  • Black & white thinking
  • Anger/rage

Overall, both narcissists and addicts or alcoholics solely pay attention to the possibility of reward, while disregarding the potential downsides of their behaviors.

Effects of Substance Abuse on Individuals with Narcissistic Personality Disorder

Just like any mental health disorder, substance abuse negatively impacts the symptoms and severity of narcissistic personality disorder. Some of the symptoms that are exasperated include lack of empathy, feelings of superiority and invincibility, and a sense of grandiosity. If an individual is continuing to use substances while attending treatment for NPD, treatment often becomes ineffective. Because the treatment of NPD can be a slow process requiring long-term treatment, lessening the positive gains through using substances can decrease development, and lengthen the time of treatment even further.

NPD and Alcohol Abuse

According to studies, nearly 22% of individuals with a narcissistic personality disorder also fit the criteria for an alcohol use disorder. While this number may seem insignificant, people with NPD suffer from alcoholism at four times the rate of the general population. Alcohol is known as the most abused substance among individuals with NPD. This may be due to the easy accessibility of alcohol as well as the increased social acceptability when compared to other substances.

NPD and Marijuana Abuse

Individuals with narcissistic personality disorder meet the criteria for drug abuse at three times the rate of the general population. Marijuana is known as the most commonly used illicit substance and is considered more socially acceptable than other drugs. As a result, individuals with NPD are more likely to abuse marijuana in hopes that they will not be judged.

NPD and Stimulant Abuse

Stimulants are another form of a drug that individuals with a narcissistic personality disorder often abuse. Oftentimes, abusing stimulants can provide individuals with increased energy and confidence – something individuals with NPD crave. Therefore, when individuals with NPD begin to feel less confident or socially inept, they may begin to abuse stimulants in order to artificially create a sense of confidence, grandiosity, or boost performance. Common forms of stimulant drugs used by individuals with NPD include Adderall, Ritalin, cocaine, methamphetamine, and ecstasy.

Treatment for Narcissistic Personality Disorder and Substance Abuse

If you or a loved one suffer from both a narcissistic personality disorder as well as a substance abuse disorder, dual-diagnosis treatment may be vital. At Pax Memphis, our dedicated staff and medical health professionals are trained to treat both mental health disorders as well as addiction. With the combination of psychotherapies, individual and group counseling, as well as a secure and safe environment, recovering from a dual-diagnosis is possible. If you would like to learn more about our dual-diagnosis treatment program,contact PAX Memphis today!

Medically Reviewed: September 25, 2019

Dr Ashley

Medical Reviewer

Chief Editor


All of the information on this page has been reviewed and verified by a certified addiction professional.

Dr Ashley Murray obtained her MBBCh Cum Laude in 2016. She currently practices in the public domain in South Africa. She has an interest in medical writing and has a keen interest in evidence-based medicine.

All of the information on this page has been reviewed and verified by a certified addiction professional.