Alcohol Use Disorder and Narcissistic Personality Disorder

Having narcissistic personality disorder increases the risk of developing unhealthy drinking habits that are problematic to treat using traditional methods. Online naltrexone and GLP-1 medications can play a crucial role in helping people with NPD control their drinking.

What You’ll Learn:

• What characteristics define narcissistic personality disorder.

• Research findings for studies that examine the connection between drinking alcohol and NPD.

• The differences between grandiose NPD and vulnerable NDP.

• The primary contributors that increase the risk of AUD in people with narcissistic personality disorder.

• The impact of interpersonal struggles that influence alcohol use.

• Why personalized treatment plans are better for people with NPD compared to traditional treatment programs.

These days many people are too quick to label others as a narcissist. But in reality, narcissistic personality disorder (NPD) affects somewhere between 1-6% of adults. In a clinical setting, up to 16% of people are diagnosed with the disorder.

Alcohol use disorder is more common across every personality disorder, not just this one. Our guide to alcohol use disorder and personality disorders breaks down the risk and the research for each one.

Diagnosis isn’t based on whether someone acts in a self-serving way. The hallmark characteristics of narcissism are a sense of entitlement, need for admiration and lack of empathy for others.

Their actions are often centered around meeting their own needs first and foremost because of their excessive sense of self-importance.

Another common issue is problematic drinking.

While research has shown there is a significant connection between NPD and unhealthy drinking habits, it’s not quite a one-to-one. There are comorbid conditions that come into play and increase the risk of alcohol dependence forming.

Large-Scale Study Confirms NPD/AUD Comorbidity

The NESARC Wave 2 study is considered one of the most extensive studies looking into alcohol use and related conditions. It involved thousands of people over the course of three years.

One of the related conditions that was studied was narcissistic personality disorder.

The consensus was that NPD coincided with alcohol dependence up to 19.6% of the time.

Other sources have put the co-occurrence at 13%, which is still higher than the general public. However, it’s right in line with other personality disorders.

While the risk may be the same for different personality disorders, many of the reasons behind the increase are unique to the type of disorder. Something that sets NPD apart is that there are subtypes that can affect the urge to drink.

The Type of Narcissism Makes a Difference With Drinking

Narcissism is interesting in that there are two distinct subtypes: grandiose and vulnerable. Which type a person is can have an influence on drinking behaviors.

Grandiose NPD is associated with an inflated sense of superiority and need for recognition. This often leads to boasting and grandiosity.

Vulnerable NPD is the exact opposite in many ways. People with vulnerable NPD may act arrogant, but it is used to conceal low self-esteem that causes sensitivity, doubt, feelings of shame and angry reactions.

Something else worth noting is that studies have found NPD has a very high rate of comorbidity with other personality disorders and mood disorders. This can significantly compound problems with alcohol use and complicate treatment.

What Contributes to Higher Alcohol Dependence Among People With Narcissistic Personality Disorder

Some of the primary characteristics that define narcissistic personality disorder are also key contributors for drinking alcohol.

While each individual has their own motivating factors that drive alcohol use, some shared contributors for people with narcissistic personality disorder include:

Sense of Entitlement

Having a sense of entitlement is the second most common characteristic of NPD for both men and women. People with NPD often feel that they don’t have to follow the rules or norms of society.

Essentially, they can do what they want and are entitled to special treatment.

That applies to drinking alcohol excessively. On top of the social norms not applying to them, there is an expectation that their needs will be accommodated, including issues related to drinking.

It’s also a major reason why people with NPD are resistant to treatment.

Low Self-Esteem

Despite seemingly being overly confident, many people with NPD actually suffer from very low self esteem and poor self esteem regulation. It’s believed to be the top contributing factor for the higher rate of alcohol dependence.

Alcohol appears to have a stabilizing effect, but it does so in different ways depending on whether the person has grandiose NPD or vulnerable NPD. And the effect is short-lived.

Interestingly, low self-esteem can also be the catalyst for envy, another key characteristic of narcissistic personality disorder. It’s connected to a higher likelihood of comparison to others, which can also perpetuate drinking.

It’s part of what’s known as the “compare and despair” cycle.

Shame (Vulnerable NPD)

Vulnerable NPD is marked by hyper-sensitivity to criticism and judgement. It can generate a sense of shame that some people dull with alcohol.

Tendency For Impulsive Actions

People with NPD have a tendency to act on their impulses. A 2024 study examined how this characteristic impacted the likelihood of problems with substance use and found a correlation.

Since alcohol inhibits the part of the brain that controls impulsive behavior drinking can make matters worse all around..

Self-Medicating to Manage Symptoms of the Personality Disorder

Like others with personality disorders or mental health issues, self-medicating to cope with symptoms of the condition is common among people with narcissistic personality disorder.

In addition to substance use disorders, NPD is associated with higher risk of major depressive disorder, severe anxiety and bipolar disorder.

One of the major issues with self-medicating is that alcohol may provide immediate relief, but the next day the symptoms they were trying to mask will be worse.

Alcohol Makes Interpersonal Struggles More Difficult to Deal With

Another related issue that has a serious influence on drinking among people with NPD is their interpersonal struggles from the personality disorder. Emotional dysregulation is at the core of their interpersonal issues with others.

Low self-esteem, impulsive behavior and mood disorders strain relationships while lack of empathy makes it harder to relate.

These interpersonal issues can be a major contributor of drinking as well as a reason for lack of treatment. With fewer close relationships a person with NPD has less support and fewer people to encourage them to seek help.

Why Personalized Treatment Plans Are Better For People With NPD Than Traditional Programs

Studies have found that there is an extremely high drop out rate for people with narcissistic personality disorder in traditional treatment programs.

As many as 64% drop out of traditional therapy that either addresses the alcohol use directly or the contributing factors.

This makes sense when you consider the characteristics associated with NPD. Every therapy session is a critique of their actions and analysis that questions what they are doing and is focused on identifying what isn’t working.

It’s in conflict with the person’s drive for perfectionism, need for admiration and tendency for defensiveness. Their ego-centric nature to not take accountability and instead blame other forces for problems also complicates treatment.

One other factor is avoidant cognitive processing. This means a person is resistant to admit behavioral mistakes and see the need to correct them.

They are less likely to learn from behavioral mistakes and take the advice of professionals that can help.

Alcohol treatment plans that are tailored to emphasize confidentiality, control over the process and taking things gradually have a better chance of long-term success.

It’s one reason why online prescription naltrexone and GLP-1 prescriptions can play a pivotal role in helping people with NPD overcome problematic drinking.

There’s less sense of shame and judgement when things are done virtually in their own home and fits around their life.

Taking a daily dose of naltrexone or weekly GLP-1 to curb alcohol cravings can be done discreetly without anyone knowing. It can be a vital first step in addressing alcohol use and set the stage for further treatment.

Struggling with a personality disorder like NPD along with problematic drinking can be overwhelming and difficult to treat.

It’s important to find the right support if you feel like you’re drinking too much or having difficulty curbing alcohol cravings.

At Choose Your Horizon patients are able to self-direct their care and always have access to qualified clinicians when needed.

There are also personal resources that can be used to track progress and visualize the improvements that are being made, which helps encourage people with NPD to stick with their treatment protocols.

If you’d like to learn more about creating a personalized alcohol use treatment plan, start with the Alcohol Use Assessment to get your Audit-C score.