Ramani Durvasula

How many times have you worked with a client experiencing addiction, and feel that no matter what you try, that you keep ending up in the same place? Did you consider the role of personality? Narcissism and the larger spectrum of antagonistic personality styles can transform addiction treatment into a far more challenging clinical issue, but also elucidate treatment resistance, lapses, and even performative/superficial recovery. All of this means that understanding these personality styles can set you up to better work with clients to prevent relapse. Narcissism can significantly complicate assessment, treatment, and long-term management with individuals living with addiction and substance use disorders (SUDs). The patterns observed in narcissistic clients often parallel those observed in addiction, and act as a multiplier creating greater difficulty in treatment engagement and relapse prevention. 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 consideration of personality or personality assessment often do not inform treatment planning. This presentation will offer a comprehensive overview of narcissism, associated behaviors, developmental and etiological issues including trauma, and the overlap between narcissism and substance use disorders. 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. Tips for maximizing clinician efficacy in working with this population will be addressed, as will the importance of realistic expectations not only for the clinician but also for family, partners/spouses, and other stakeholders.