Where Do I Begin? When Narcissism and Addiction Co-Occur

Maladaptive personality styles, particularly antagonistic patterns such as narcissism, can significantly complicate assessment, treatment, and long-term management with individuals living with addiction and substance use disorders (SUDS). Relational and intrapsychic dynamics can present as part of both substance use and antagonistic personality styles, and we also observe significant interpersonal disruption which will impact treatment engagement and relapse management. It is also known that substance use/addiction and narcissism overlap with 25-50% of persons with narcissistic personality disorder (NPD) presenting with a co-occurring SUD (Stinson et al., 2008). But we often overlook personality when working with clients living with addiction, and personality assessment often does not inform treatment planning. This presentation will offer a comprehensive of narcissism and NPD, including the AMPD formulation offered by DSM, relationship dynamics, developmental and etiological issues including trauma, and the overlap between narcissism and substance use disorders. We will also review the overlaps and discrimination between narcissism and antisocial personality disorder/psychopathy. Dynamics such as shame, saving face, and validation seeking as part of the recovery process will also be addressed. Working with narcissistic clients who are managing co-occurring substance use remains a significant challenge for clinicians, and can raise a sense of helplessness, frustration, and other potentially problematic counter-transferential dynamics. Intersectional issues related to race, social class and economic status will also be addressed. Tips for maximizing clinician efficacy in working with this population will be addressed, as will the important of realistic expectations not only for the clinician but also for family, partners/spouses, and other stakeholders.