I am a specialist in Cluster B personality disorders who has worked with people with disabilities and mental illnesses for over 10 years.
There is a wealth of information regarding this topic, and the link between high levels of narcissism and substance abuse is well-documented. And that makes sense. Narcissists are highly emotional people, whether they show it or not. They are often inundated with emotion, frequently depressed, anxious or afraid, or all of the above, and chronically empty. They've never learned how to deal with their feelings, and subsequently, they often feel overwhelmed by them, so they need to escape from this constant barrage of feeling or fill that gnawing emptiness, and many of them turn to drugs or alcohol to do so.
Why? Narcissists learned early on that they cannot depend on people. They learned that they can't trust them and that they are not safe with them. Now, many people have learned that in life, but they don't turn to drugs and alcohol because they are secure in themselves. Unfortunately for narcissists, they do not trust themselves either. This puts them in a scary, insecure position where they feel alone in the world with nowhere to turn and no one to trust - not even themselves. So they deaden the feelings, the fear and the self-hatred with substance abuse. This is often referred to as self-medicating. As opposed to just using substances to get high or to get drunk, narcissists are often using them to counteract the difficulties they are having because of their psychological problems. Of course, they usually find out what most people eventually find out: this doesn't work. It's like that old saying: wherever you go, there you are. Ignoring or covering problems up does not make them go away. It usually makes them worse.
Narcissists are in some ways the perfect candidates for addiction. They are severely emotionally dysfunctional, they live in denial, they have problems with impulsivity, with taking responsibility, they have an excuse for everything and nothing is ever their fault. They already don't care about themselves, so slow suicide with drugs or alcohol is not a hard leap for them at all. Recent research suggests along with their poor impulse control, pathologically narcissistic people's brains are overly focused on rewards. They have overactive reward centers in their brains. One study showed that their brains released up to 4 times more dopamine when rewarded than an average brain. This can explain a lot of their behavior, and especially their problems with substance abuse. They are focused on the reward of using drugs and the other things—such as consequences of using them, or hurting others or anything else—do not matter. We often hear people say, "It's not the having, it's the getting," meaning the journey to the goal is just as important—or more important—than achieving the goal. For narcissistic people, the having is all that matters. Of course, this is no surprise to those who have dealt with narcissists. When they want something, they want it. They will never let go of it and they will cause suffering and problems until they get it.
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Sometimes, an addiction is discovered by a change in the person's behavior and sometimes, narcissism that was previously unknown is discovered by treatment for an addiction. Loved ones who have suffered through their family member or friend's addiction and are hoping to finally see the end of the nightmare are stunned to find out that even cold sober, their family member or friend still behaves the same way. This is because even when the addiction is cured, the narcissism remains. This can leave the narcissist's loved ones at a loss to know what to do. If they connect the dots and discover that narcissism could be the problem, they are left with a hard question: did this person become narcissistic because of years of addiction, or did they become an addict because they were a narcissist?
This is a difficult question. It's kind of like a chicken and egg type of thing: which came first, the narcissism or the addiction? Addiction can definitely create a narcissistic mindset, and addicts generally behave very narcissistically. You could argue conversely that addiction itself is narcissistic, and that those who fall into addiction are probably already narcissistic on some level. You'll probably never really know. Even when the addiction is gone, if the person still exhibits narcissistic behavior it is still nearly impossible to know for sure if they were already narcissistic beforehand or if they "grew into" this behavior from years of substance abuse. It doesn't really matter either way because whether the narcissism was there already or whether it's a byproduct of addiction, it's there now.
This creates a sticky situation for loved ones because while extending unconditional empathy, sympathy, and compassion is great for supporting a loved one dealing with basic addiction, this is the wrong approach when dealing with narcissists. It only feeds their other addiction: attention. It can actually make their overall problem worse, not better because it teaches the narcissist that they can get what they want through substance abuse, either by using or by stopping. The truth is that you cannot help an addicted narcissist any more than you can help one who isn't addicted. They have all of the same problems, but also with the added excuse of substance abuse and all the horrible baggage that comes with that. A general rule of thumb when dealing with both addicts and narcissists is boundaries, boundaries, boundaries. Otherwise, you will probably find yourself being taken advantage of.
Addiction and recovery offer many opportunities for the attention-seeking narcissist. They can receive praise, sympathy and much more. There are 12-step programs to exploit, group meetings to capitalize on, well-meaning people to take advantage of endless excuses for their behavior. The irony is that even though initially the positive attention they are receiving may help them stop using drugs or drinking because they don't need to numb their feelings so much, as soon as it's gone they will often be right back to it. The narcissist's need for attention is stronger than the addiction to any substance. They can live without drugs and without alcohol. They cannot live without attention.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.