Narcissism and alcoholism are two distinct conditions but share some traits. They can also occur together.

If you know someone who regularly uses alcohol, it’s possible that narcissism might be one of the influencing factors. Research supports the link between some narcissistic traits and alcohol use.

Narcissism and alcoholism also share some symptoms, although what drives these traits is a little different between the two conditions.

People use alcohol for a variety of reasons. It can be a part of celebratory occasions and fun, or an occasional way to unwind after a long day. For some people, alcohol use becomes regular and problematic and may lead to dependence.

There isn’t a single cause of alcohol use disorder (AUD), but factors that may contribute include:

  • genetics
  • cognition
  • home environment
  • peer interactions
  • psychiatric disorders
  • personality disorders

Personality disorders are mental health conditions involving pervasive and often destructive personality traits. Narcissism is one such example.

Narcissistic personality disorder (NPD) is one of the Cluster B personality disorders, which are characterized by unpredictable and emotional behavior. Personality disorders are grouped into clusters based on similar traits.

Personality disorders and substance use disorders occur together about 22.6% of the time, according to the National Institute of Mental Health (NIMH).

A 2019 study found a link between vulnerable narcissism, shame, and an increased likelihood of problem drinking and gambling. Vulnerable narcissism features traits like low self-esteem, helplessness, and rejection sensitivity.

Aggressive behavior and pathological narcissism were linked to alcohol overuse in a 2017 study of Canadian men. The association remained intact even when researchers accounted for general psychological distress as a trigger for coping responses like alcohol use.

Another study from 2019 found a link between drinking and the narcissistic traits of devaluing and entitlement-rage. Threatened egotism was listed as a factor that motivated increased alcohol use.

To determine whether a person simply has narcissistic or alcoholism traits instead of a disorder, clinicians use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) to see if a person meets the criteria for an official diagnosis.

AUD diagnosis

The DSM-5-TR lists 11 criteria that may indicate the presence of AUD. The 11 criteria are:

  1. tolerance
  2. symptoms of withdrawal
  3. desire or attempts to reduce amount or stop
  4. larger quantities, longer time
  5. sacrificing important activities to use alcohol
  6. a lot of time spent using alcohol
  7. continued alcohol use despite physical or psychological problems
  8. alcohol cravings
  9. alcohol use that is physically hazardous
  10. inability to meet obligations to work, home, or school because of alcohol use
  11. persistent interpersonal or social problems

The number of criteria a person meets determines whether they have AUD, and if so, the severity of the condition.

Number of criteriaAUD severity
0-1no AUD
6 and highersevere

NPD diagnosis

For a person to meet the requirements of an NPD diagnosis, they must have:

These tendencies need to have begun early in adulthood, and be embodied by five or more of the following signs:

  • arrogance and haughtiness
  • entitlement and expectation of preferential treatment
  • envy, either toward others or the belief that others envy them
  • unwillingness to recognize the needs of others
  • exploitation of people to reach their own goals
  • a need for admiration from others
  • elitist perspective
  • preoccupation with success, brilliance, power, perfect love, or beauty
  • grandiose self-importance and exaggerated view of their own achievements

A trained mental health professional is usually able to diagnose personality disorders using standardized psychiatric interview methods.

NPD and AUD have some shared traits. The underlying cause of each is sometimes not the same, but the behaviors can seem very similar.

TraitPerson with NPDPerson with AUD
Denialthinks they can do no wrongthinks their alcohol use is under control
Lack of accountabilityblames other people for their problemsblames other people for their alcohol use
Entitlementfeels entitled to do what they wantfeels entitled to indulge in alcohol use
Rapidly changing behaviorexperiences changing moods if their self-esteem is threatenedexperiences behavioral instability from the effects of alcohol
Manipulationmanipulates others to get what they wantmanipulates people and situations to enable their alcohol use
Self-absorptionis concerned primarily with satisfying their own emotional needsis concerned primarily with maintaining their ability to use alcohol
Shamemasks their own shame by projecting inflated self-importancemasks their own shame with alcohol use
Lack of introspectionis unwilling to consider their imperfectionsis unwilling to examine the reasons they use alcohol

Both AUD and NPD can be treated.

AUD treatment options include:

  • behavioral treatments, like counseling
  • medications to help a person reduce or stop their alcohol use
  • support groups, like Alcoholics Anonymous

NPD treatment is usually ongoing therapy.

There are no medications approved by the FDA to treat NPD. But, a person with NPD may benefit from medication for any accompanying issue they may be dealing with, such as:

  • anxiety
  • depression
  • transient psychosis
  • mood volatility
  • impulse control issues

When AUD and NPD occur together, it can increase a person’s hostility and aggression. This can make treatment more challenging than it would be to treat each issue separately.

A person with both AUD and NDP may wish to try therapy. Options include:

If you or someone you know is interested in exploring treatment for AUD and NPD, there are resources available.

The first step is to consult with a primary care doctor, who can recommend a treatment plan or suggest a referral. Other healthcare professionals who may be able to help include:

  • psychiatrist
  • psychologist
  • alcohol counselor
  • social worker

You can also visit Psych Central’s mental health resource hub, which has information about how to find mental health support.