a,b
a
b
a
Rebecca R. Carter ; Shannon M. Johnson , BA; Julie J. Exline , Ph.D ; Maria E. Pagano , Ph.D
a
Department of Psychology, Case Western Reserve University, Cleveland, OH ; Department of Psychiatry, Case Western Reserve / University Hospitals Case Medical Center, Cleveland, OH
BACKGROUND
The nation’s most commonly sought out treatment modality for substance abuse
problems, Alcoholics Anonymous (AA), claims egocentrism as a root cause of
addiction. Synonyms for ego-centrism in AA literature are: narcissistic behaviors, selfcenteredness, extreme self-absorption, and grandiosity. In tandem with AA’s theory,
clinicians have often noted narcissistic behaviors among individuals with substance
abuse problems. In Freud’s id-ego terminology, substance abuse was characterized as
an oral longing and a sign of narcissistic despair (1, 2). Modern theory on narcissistic
pathology and ego development describes the narcissism/addiction link as a pattern of
yielding to inner urges in a way that proves costly and self-destructive (3). AA’s solution
to treat the narcissistic root cause of addiction is to continually get out of self by helping
others (4).
MEASURES
Narcissistic Behaviors
The Narcissistic Personality Inventory (14) is a 40-item self-report
Prosocial Behaviors.
Prosocial behaviors were assessed using the five items from the General
measure designed to measure subclinical individual differences in
Social Survey: giving food or money to a homeless person, doing volunteer
work for a charity, giving money to a charity, looking after a person’s home
narcissism. The NPI has 7 subscales: authority, exhibitionism, superiority,
entitlement, exploitativeness, self-sufficiency, and vanity (14). The NPI has
while they are away, and carrying a stranger’s belongings (18). Items are
been used with youth and adult normative populations and adult clinical
rated from 1 (more than once a week) to 6 (not at all in the past year) with
populations (14, 15, 16). The NPI has demonstrated good psychometric
reference to the past year. The GSS has been used with national normative
properties, including internal consistency (α = 0.82, 13) and test-retest
samples (18). These subscale items of the GSS demonstrates adequate
internal reliability (α = 0.61) and construct validity (rs = 0.07 – 0.13, 18).
reliability (rs= 0.57 – 0.81, 17).
Given that AA originated in 1939 and the epidemic rise of addiction in our nation’s
minors, the paucity of empiricism supporting the link between elevated narcissistic
behaviors and addiction in youth is surprising. One of the inherent challenges to
understand this link lies between the terms ego-centrism and ego development during
adolescence (5). Normative developmental processes in adolescence are characterized
by heightened sensitivity, self-absorption, and preoccupation with self (6). In contrast,
the defining characteristics of narcissism include a grandiose sense of self-importance,
a tendency to exaggerate accomplishments and talents, and an expectation to be
noticed as “special” even without appropriate achievement (7, 8). Another inherent
challenge addiction research scientists face pertains to a 21st century cohort effect
observed among today’s youths. This cohort effect is commonly referred to as the “Me
Generation” and can be traced back to the self-esteem movement of the 1980s. Some
claim that the effort to build self-confidence among adolescents has gone too far,
resulting in a generation of youths who lack empathy, react aggressively to criticism and
favor self-promotion over helping others (9).
Addiction research involving adolescents has largely been preventive; a large body of
literature identifies factors that reduce the likelihood of developing substance abuse
problems. This study uses a large, representative sample of adolescents who have
developed substance dependency disorder (SDD) to test AA’s theory of the link between
elevated narcissistic behaviors and addiction.
STATISTICAL ANALYSIS
Depending on the type of variables (continuous or discrete), analysis of variance (ANOVA) or chi-square analyses were performed to examine the
characteristics of the clinical sample. Random effect regression analyses were performed using a nested pair cluster to absorb pair-specific effects. Our
dependent variables were two types of other-oriented behaviors: narcissistic behaviors measured with 7 NPI subscales, and prosocial behaviors measured with
REFERENCES
RESULTS
1.
TABLE 1. Demographic and Clinical Characteristics of ND Sample
Variable
Category
Level
Gender
Male
Minority
34 (30%)
Ethnicity
Hispanic
10 (9%)
Single-parent household
Yes
53 (46%)
Learning disability
Yes
12 (10%)
Grade
Less than 8 years
Middle school
Partial high school
High School
2 (2%)
20 (17%)
88 (77%)
5 (4%)
Age
M (SD)
16.23 (1.71)
Parental History of SDD
Yes
60 (52%)
History of Legal Problems
No. of Arrests* (M, SD).
No. of Felonies* (M, SD)
History of Assault (Yes)
History of Robbery (Yes)
History of Burglary (Yes)
Ever on Parole/Probation (Yes)
Ever Jailed/Incarcerated (Yes)
2.77 (2.73)
0.53 (1.17)
34 (30%)
20 (17%)
19 (17%)
100 (87%)
77 (67%)
Sexual (Yes)
Physical (Yes)
30 (26%)
27 (23%)
(Yes)
(Yes)
28 (24%)
38 (33%)
History of Abuse
reported by adolescents with SDD in comparison to large scale youth surveys
History of Suicide Attempts
History of Self Mutilation
TABLE 2. Narcissistic Personality Inventory Scores: Comparison Between Youths With and Without Substance Dependency
NPI Subscale Score
Total (N, %)
Youths (Normative)
Youths with Substance Dependency
230 (100%)
115 (50%)
115 (50%)
Authority (M, SD)
4.34 (2.11)
3.87 (2.22)
4.81 (1.88)**
Total (N, %)
115 (100%)
60 (52%)
Race
The purpose of this study is to explore narcissistic and prosocial behaviors as
Entitlement (M, SD)
Using a quasi-experimental design, this study compares narcissistic and prosocial
behaviors of adolescents with SDD to normative controls, matched by age and
2.17 (1.54)
1.97 (1.61)
2.37 (1.43)*
2.
3.
4.
5.
6.
Exhibitionism (M, SD)
Exploitativeness (M, SD)
2.35 (1.79)
1.85 (1.40)
1.97 (1.61)
1.50 (1.38)
2.37 (1.43)***
2.20 (1.33)***
7.
8.
9.
Superiority (M, SD)
2.48 (1.40)
2.35 (1.42)
2.61 (1.39)
10.
Self-Sufficiency (M, SD)
2.37 (1.37)
2.36 (1.52)
2.39 (1.21)
Vanity (M, SD)
1.25 (1.11)
1.02 (1.12)
1.49 (1.07)**
11.
12.
NOTES:
*
p < .05
**
p < .01
*** p < .0001
NOTES:
* Assessed over the past two years
METHOD
To the best of our knowledge, this study is the first to examine
other-oriented behaviors that distinguish youths with
SDD. Remarkably, most other-oriented behaviors were similar
between youths with and without SDD. The other-oriented
behaviors that distinguished youths with SDD were overt
narcissistic behaviors and reduced monetary donations. The
matched-pair design of the current study, and same decade in
which all youth were interviewed, address the potential confounds
of age, gender, and cohort influences to study results. Our results
indicate that narcissistic and prosocial behaviors are multi-faceted
constructs, certain facets of which appear related to addiction.
This study was cross-sectional; therefore the significant
differences found are associations rather than causations.
Considering the ethical concerns of randomizing youth to develop
addiction, a longitudinal within-subjects design whereby each
subject serves as his/her own control is warranted to demonstrate
causation. Moving out of self towards others may be particularly
relevant towards adolescents with substance abuse
problems. Results may inform professionals interested in youth
development and youth treatment.
5 GSS items. We reported all two-tailed tests with an alpha level of p < 0.05. Analyses were performed using SAS version 9.1.3.
OBJECTIVE
collected in the past decade.
DISCUSSION
MEASURES
Two types of other-oriented behaviors were measured:
narcissistic and prosocial behaviors.
13.
14.
A total of 115 substance dependent youth (14-18 years old) were enrolled in this study.
Approximately half were female (48%), came from a single parent home (46%), and had a
parent with a substance use disorder (52%). This sample included a considerable minority
group (30%).
In comparison to adolescent controls, SDD youth scored significantly higher in the areas
of entitlement (F=2.37, p<.05), exhibitionism (F=2.37, p<.0001), exploitativeness (F=2.20,
p<.0001), and vanity (F=1.49, p<.001).
15.
16.
gender. This design was selected over the standard randomized, controlled field
17.
experiment design given the ethical issues of assigning adolescents to a disease
condition. Comparison groups were matched with identified relevant variables;
prosocial behaviors have been known to increase with age while gender differences
in prosocial behaviors have also been well documented (10, 11). Thus, each
adolescent with SDD was matched to a youth control by age and gender. Inclusion
criteria for the clinical sample included: possessing stable contact information, being
between the ages of 14 and 18, meeting DSM-IV diagnostic criteria for substance
dependency, and being medically detoxified. Exclusion criteria included: being
illiterate, having major chronic health problems requiring hospitalization, and being
suicidal or homicidal. For youth controls, two survey samples were
selected. Detailed information regarding the research designs of the two survey
samples selected as normative controls is explicated elsewhere (12, 13). The
TABLE 3. General Social Survey Scores: Comparison Between Youths With and Without Substance Dependency
General Social Survey (GSS) Item
Youths (Normative) N=131
Youths with Substance Dependency (N=115)
Gives money to charity (M, SD)
4.66 (1.31)
5.06 (1.15)***
Gives food/money to homeless (M, SD)
4.45 (1.44)
4.80 (1.17)***
Looks after neighbor’s plants/mail/pets (M, SD)
4.88 (1.33)
4.67 (1.36)
Volunteers (M, SD)
4.98 (1.34)
4.84 (1.38)
Carries belongings for stranger (M, SD)
4.95 (1.23)
4.46 (1.20)*
GSS Total Score
23.93 (3.98)
23.82 (4.30)
NOTES:
*p < .05, **p < .01, ***p < .0001
GSS items are rated: 1= “more than once a week”, 2= “once a week”, 3= “once a month”; 4= “2-3 times in past year”, 5= “once in past year”; 6= “not at all”.
current study was approved by the University Hospitals/Case Medical Center
Institutional Review Board.
b
When GSS items were compared for addicted youth and non-addicted youth, adolescents with
SDD were less likely to give money to charity (F=5.06, p<.0001) or give to the homeless (F=4.80,
p<.0001) in comparison to adolescent controls.
18.
Abraham K. (1908). The Psychological Relations between sexuality and alcoholism. In (1973),
Selected Papers on Psychoanalysis. London: Hogarth Press.
Freud, Sigmund. (1887-1904). The Complete Letters of Sigmund Freud to Wilhelm Fliess.
Translated and edited by Jeffrey Moussaieff Masson (1985). Cambridge, MA: Harvard University
Press.
Baumeister, R. F., & Vohs, K. D. (2001). Narcissism as addiction to esteem. Psychological
Inquiry, 12, 206–210.
Zemore S.E.,& Pagano M.E. (2007). Kickbacks from helping others: Health and recovery. In:
Galanter M, Kaskutas L, editors. Recent developments in alcoholism. Vol. 10. New York: Plenum.
Keagan, R. (1982). The Evolving Self: Problem and Process in Human
Development. Cambridge, MA: Harvard University Press.
Youniss, J., & Smollar, J. (1990). Self through relationship development. In H. Bosma & S.
Jackson (Eds.), Coping and self-concept in adolescence (pp.129-148). Berlin: Springer Verlag.
Kohut, H. (1971). The Analysis of the Self. New York: Int. Univ. Press.
Millon, T. (1990). The disorders of personality. In L.A. Pervin (Ed.), Handbook of personality:
Theory and research (pp. 339-390). New York: Guilford Press.
Twenge, J. M. (2006). Generation Me: Why today’s young Americans are more confident,
assertive, entitled—and more miserable than ever before. New York: Free Press.
Gilligan, C. (1982). In a different voice: Psychological theory and women's
development. Cambridge, MA: Harvard University Press.
McAdams, D. P., Hart, H. M., & Maruna, S. (1998). The anatomy of generativity. In D. P.
McAdams & E. de St. Aubin (Eds.), Generativity and adult development: How and why we care
for the next generation (pp. 7–44). Washington, DC: American Psychological Association.
Davis, J A., Tom W. S., and Marsden, P.V. (2003). General social surveys, 1972–2002
(cumulative file, computer file). 2nd ICPSR version. Chicago, IL: National Opinion Research
Center (producer); Storrs, CT: Roper Center for Public Opinion Research, University of
Connecticut; and Ann Arbor, MI: Interuniversity Consortium for Political and Social Research
(distributors).
Exline, J. J., Baumeister, R. F., Bushman, B. J., Campbell, W. K., & Finkel, E. J. (2004). Too
proud to let go: Narcissistic entitlement as a barrier to forgiveness. Journal of Personality and
Social Psychology, 87, 894–912.
Raskin, R., & Terry, H. (1988). A principal-components analysis of the Narcissistic Personality
Inventory and further evidence of its construct validity. Journal of Personality and Social
Psychology, 54, 890-902.
Prifitera, A., & Ryan, J. J. (1984). Validity of the Narcissistic Personality Inventory (NPI) in a
psychiatric sample. Journal of Clinical Psychology, 40, 140-142.
Shulman, D. G., McCarthy, E.C., & Ferguson, G.R. (1988). The projective assessment of
narcissism: Development, reliability, and validity of the N-P. Psychoanalytic Psychology, 5(3),
285-297.
del Rosario, P. M., & White, R. M. (2005). The Narcissistic Personality Inventory: Test-retest
stability and internal consistency. Personality and Individual Differences, 39, 1075-1081.
Smith, T.W. (2005). Altruism and Empathy in America: Trends and Correlates. Retrieved
September, 1, 2009, from http:// http://www.norc.uchicago.edu/NR/rdonlyres/7EFE80C6FD3A46F7-AF22-ACE5C9E34E14/0/ AltruismandEmpathyinAmerica.pdf.
ACKNOWLEDGEMENTS
This study was supported in part by a grant award (K01
AA015137) from the National Institute on Alcohol Abuse and
Alcoholism (NIAAA) and a grant award (#13591) from the John
Templeton Foundation to Dr. Pagano. The authors thank New
Directions, an adolescent residential treatment facility in Ohio,
for their assistance in the data collection. Analysis and poster
preparation were supported by the Department of Psychiatry,
Division of Child Psychiatry, Case Western Reserve University,
Cleveland, OH. The authors and presenters report no other
financial support or affiliations to disclose.