Dr. Ramani Durvasula: Understanding Narcissism Through Relationships And Addiction

ILBS 18 | Understanding Narcissism


Without proper rehabilitation for narcissistic people, helping them deal with their psychological difficulties is challenging. On top of the tedious task of understanding narcissism, there’s also their higher potential to resort to substance abuse just to address their needs. Going deep into this mental health issue with Tim Westbrook is Dr. Ramani Durvasula, a clinical psychologist and certified narcissist expert. Together, they discuss how a narcissistic personality is typically fueled by insecurity, manipulation, frustration, and disappointment, leading to drug addiction and alcoholism if pushed to the limits. They also talk about how to properly approach and mingle with such people, especially when getting into a close relationship with them that may involve gaslighting, unbalanced emotions, and numerous relapses.

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Dr. Ramani Durvasula: Understanding Narcissism Through Relationships And Addiction

My team and I over the course of many years have helped thousands of people on their path to recovery. We started the show because there’s so much misinformation about addiction treatment, mental illness and recovery in general. There’s so much more to recovery than just going to inpatient treatment or going to Twelve-Step programs or seeing a therapist. I’m a huge advocate for the Twelve-Step program, AA saved my life but there’s more to it. To find long-term recovery, my experience and what I’ve seen is for a person to live happy, joyous and free, there’s a lot more to it. That comes down to lifestyle habits and living a different and honest life. It’s much more than just stopping drinking, drugs and addictive behavior. Those are the types of things that we talk about on this show.

I’m happy and excited to have Dr. Ramani. She is a licensed clinical psychologist in Los Angeles, California, and professor of Psychology at California State University, Los Angeles. She is also a visiting professor at the University of Johannesburg. Additionally, she is the Founder of LUNA Education Training and Consulting, LLC, a company focused on providing content and education about high conflict and antagonistic personality styles such as narcissism and their impact on mental health, relationships, families and the workplace.

Dr. Ramani is also the Co-founder of the Narcissistic Abuse Awareness Alliance, a collaborative professional group of therapists and coaches working with clients, experiencing these relationships. She takes on entitlement and incivility in “Don’t You Know Who I Am?”: How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. She’s the author of the modern relationships survival manual, Should I Stay or Should I Go: Surviving A Relationship with a Narcissist and You Are Why You Eat: Change Your Food Attitude, Change Your Life.

She also has a popular YouTube channel that focuses on narcissism and difficult relationships. Her work has been featured at TEDx on a wide range of media platforms, including the Today Show, Discovery and Bravo. Her research on personality disorders has been funded by the National Institutes of Health, and she is a consulting editor of the Scientific Journal of Behavioral Medicine. Dr. Ramani is an honest, authentic and brutally honest voice on the struggles raised by narcissism in the US and globally. Dr. Ramani, I’m grateful to have you here. Thank you.

It’s my pleasure.

We’re going to talk about narcissism and how it relates to addiction. Can you treat narcissism? Is there a Twelve-Step group for narcissism? There’s a lot. This is a week’s subject, especially over the past few years in the news. Welcome to the show.

Thank you for having me, Tim. It’s so nice to see you again.

ILBS 18 | Understanding Narcissism

Understanding Narcissism: The 2016 elections pushed the world into the public consciousness and started a quiet buildup of people talking about different issues.


Tell me about your journey and how you got to where you are now?

In my journey, I was trained as a traditional clinical psychologist headed for my research and academic career, which I’ve done. As I was doing my research, I was a professor at Cal State LA, I started noticing a pattern that had been brought to me by students that were working out in the field in a clinical setting. They’d come back to our main setting and they’d be exhausted. They’d say, “These people are difficult.” I was listening to them, and the pattern they were describing was of this high conflict, antagonistic style, and it never changes. These patients were wreaking havoc on clinic staff and on the front-line staff. I thought, “These people are almost sucking up more resources as one person in these places than fifteen other healthy people would.” That led to an area of research, looking specifically at personality disorders, specifically in the area of HIV and how it was associated with a whole bunch of a whole host of outcomes.

I also have a clinical practice. I’m a licensed psychologist. In my practice, I was seeing people coming up over and over with describing marriages, sometimes families of origin characterized by similar patterns, people who were rigid, difficult, manipulative, unempathetic and entitled. I would talk them through it and say, “This is a pattern that’s not likely to change.” Over time, I’ve read more of the literature. It was clear that these people do not change if you have this narcissistic pattern that culminated in my book, Should I Stay Or Should I Go?

I was still doing this work very quietly. The 2016 election took this word and pushed it into the public consciousness. What was happening was there was this slow, quiet, buildup of people talking about these issues. The word came much more into the public lexicon. I started working with more clients and I’m like, “This is a problem. The mental health world doesn’t want to identify it. This is troubling because a lot of mental health practitioners aren’t trained in it, didn’t think it was a thing, we can work on anything, don’t to be mean to the narcissist. They’ve gone through a lot too.” What we found is we’d almost become a culture made up of three sets of people: the narcissists, their enablers and the people who were being victimized by both the narcissist and their enablers. I said, “This is not going to work well. If the mental health world won’t talk about this, then I will.” That’s how I solely got up into launching this YouTube channel. When the magnitude of the issue hit me, I thought, “This is going to require me almost going off book a little bit and creating public awareness of this issue,” because a lot of people either can’t afford the help and a lot of therapists out there aren’t trained to give the help. That’s how I got here. That’s the journey.

I’ve done a little bit of searching on the internet prior to meeting with you, and there are not a lot of people that are talking about narcissism on the internet.

There are a lot of people talking about it, but a lot of it is not being done by traditional mental health practitioners. That makes sense because there are over nine million YouTube videos on narcissism. The thing is that many times they’re coming at it from the perspective of, “This happened to me,” and it’s very first person, versus things that are grounded in what little science there is out there and saying to people, “Here’s what we know. Here’s what we don’t know. Here’s what you want to keep in mind and here’s how you can move forward.” That’s the piece that if people are still struggling with is, “How do we help people who are being affected by these relationships?” It turns out that I do work with clients who are narcissistic. I feel like Sisyphus. I push the rock up and pull the rocks back down at the bottom of the hill over and over again. There’s very little change here.

Is narcissism on a spectrum?

Narcissism is usually seen from the perspective of the people who experience them rather than the narcissists themselves. Click To Tweet

It is on a spectrum. At the milder ends of the spectrum, you have someone who’s a bit more almost psychologically immature and emotionally stunted. They’re the people who are forever stuck in adolescence, poorly regulated, they concern themselves with somewhat more immature pursuits and concerns. They’re 60 years old and still got to make sure they have a hot girlfriend. There’s not a lot of substance, but they’re not harmful. They’re superficial. They tend to be validation seeking. At 65, they’re still doctoring up their images online so they look good on Instagram. There’s a stuntedness to it, but the malevolent cruelty. At the other end of the spectrum, that’s where we see people who are exploitative, manipulative, sadistic, dangerously paranoid, harmful, can be dangerous in close relationships, can be dangerous if they’re in your family, and not just dangerous from a criminal perspective, but psychologically.

What is narcissism?

Narcissism is a personality style that is characterized by a lack of empathy, entitlement, grandiosity, arrogance, a chronic need for admiration and validation, arrogance, superficiality, difficulty frustrating, difficulty in regulating emotional states related to things like frustration and disappointment, and poor stress tolerance. They have a need to control other people or at least control the narrative. They have tremendous hypersensitivity to criticism, hypocrisy. They can dish it out, they can’t take it. At the core of it all, they’re deeply insecure. That insecurity can come out as victimhood, sullenness, resentfulness, particularly if they don’t get their own way. When you first meet the narcissist because of the grandiose exterior, they can come off as very charming, charismatic and confident, which is why a lot of people get sucked.

Why is it important to understand narcissism?

It’s critical in the day and age in which we find ourselves to understand narcissism for myriad reasons. The foremost is so you don’t end up with somebody like this. To have an intimate relationship like this is not good for you. To marry someone like this is potentially physically dangerous for you. To try to raise kids with someone like this is going to mess up the kids and you, especially, if you get a divorce, and you face a very contentious custody fight. It also has implications for things like the workplace. A lot of people say, “This guy is toxic but it’s the best place in town to work.” Before you know it, your therapy bills outweigh any extra money you made working at such a hotshot place because that kind of toxic boss was unsettling.

This could be a family of origin issue. By understanding what these patterns are, people are less likely to personalize what happened in their family of origin and an invalidating manipulative parent, instead of it being the narrative one may carry of, “I’m not enough.” It’s rather that person was not fit to raise kids, “That wasn’t my fault. It was just my bad luck.” By understanding this, you can be a better gatekeeper for yourself. We do live in a world that enables these patterns, “Give them the benefit of the doubt. Give him a second chance. That’s just how he talks. That’s what she says. She doesn’t mean it. They don’t mean it.” We hear that all the time and people are like, “Every cell in my body is telling me this isn’t cool, but I don’t want to be the person who seems judgmental and dismissive.”

That’s how it happens. There are many enabling voices out there. We’re obsessed with forgiveness. You don’t need to forgive. You can let it go, but you don’t need to forgive somebody who had no problem dehumanizing you and invalidating you. I tell people, “Abuse is abuse regardless of the backstory.” People will often say, “This person had a rough start. Their dad was rough on them. Another parent was an alcoholic, so it’s hard for them to connect intimately with other people.” I say, “I feel for them, and I work with clients like that all the time. However, you were not put on this Earth to be their punching bag. Abuse is abuse regardless of the backstory. That’s why this is important to understand.”

ILBS 18 | Understanding Narcissism

Understanding Narcissism: People always get into relationships with narcissists because they don’t fully understand this condition.


It’s one thing to be compassionate and understanding of their situation, however, having boundaries. It’s like, “I can be sympathetic or empathetic this person. However, these are my boundaries. I don’t need to get into a relationship with this person.”

I call it compassion from a distance. I don’t want people who’ve gone through these relationships to find themselves in this position where they feel as though they’ve become the monster. They’ve gone into Nietzsche’s abyss and they’ve become the monster. That’s not a good feeling either. I said, “It’s not about becoming the monster and cutting off all compassion, but it’s also not about throwing yourself in headlong and continually getting hurt by this person. At some point you can say, ‘That person’s got a rough backstory. I hope they find their path. That path is not going to include me.’”

A lot of times, people attract the same type of person into their life. If a person attracts a narcissist, are they likely to continue attracting a narcissist the next time?

The reason that endless cycle happens of people getting into relationships with people who have these narcissistic styles is that they don’t understand it. This is why information and knowledge are everything because what will sometimes happen is a person will get into a narcissistic intimate relationship in adulthood, and it’ll go south. Perhaps even the narcissist will leave them or they’ll leave the narcissist, maybe the narcissist has cheated or something. They won’t understand what they left. They’ll say, “That was toxic. That didn’t feel good,” but they won’t understand some of the key elements like radical acceptance, “This is not going to change, and that there was nothing you could have done to make it different.”

If there’s a real exam and look at like, “This is what this is. This is the architecture. This is what was happening and this is not going to change.” When I see these particular patterns, these are red flags that it can’t be blindly going through the relationship and then going into another because you will pick the same person. I’ll often say when a person leaves a toxic relationship, I recommend one-year emotional dialysis, a type that’s recommended in sobriety to this concept is not being in a relationship. The same thing with narcissism. I say, “Give yourself a year because by giving yourself a year, you will become well acquainted with your rhythms, your values, what’s important to you and a new person will be less likely to come in and attempt to coop that because you had a chance to build that muscle.”

When I first got clean and sober, I followed the suggestion. I didn’t take it for a year and it was the best thing that I did because I got to dig, learn more about myself, learn to be with myself, I wasn’t relying on another person to make me happy, I wasn’t relying on external validation. Next thing you know, I was a healthier person. Therefore, I attracted a healthier person in my life.

You learned your no and saying, “This doesn’t feel good.” You learn to value yourself enough to lay down the boundary. Boundaries are something that people often don’t feel that they deserve to set. A person almost needs to get themselves elevated to learn their no.

You were not put on this earth to be a punching bag. Abuse is abuse regardless of the backstory. Click To Tweet

What is gaslighting?

Gaslighting is a form of emotional abuse and manipulation where a person’s reality is doubted or denied. In its most simple form, it would be me saying to you something like, “You have no right to feel that way. It didn’t happen the way you said.” If some of that is not enough, you’ll say, “Maybe that didn’t happen.” People start doing things like surreptitiously recording conversations saying, “It did happen.” Sometimes it can even be literally physical manipulation of an environment where for example, to mess with you, a person might move the keys or move the television remote and you’ll say, “Where’s the key?” You might’ve usually put them in a bowl and the other person is like, “I didn’t move them,” but they did.

While any of those episodes are gaslighting episodes, as far as I see it, the way I see it is gaslighting is a grooming process, “Over time, you have no right to feel that way. That’s not a valid emotion. It never happened that way. I never said that. You seem to be losing your grip on reality. You’re forgetting things a lot lately.” You hear that enough 3 or 5 or 10 times a day. You have some level of trust in the gaslighter. They’re your spouse, family member, someone you know, and for some reason, you give some respect to them, they have even more power. By diminishing you through all this doubt, over time the gaslighter owns the person they’ve gaslighted. Before you know it, the gaslighted person is almost consenting in the sense that they’re capitulating. It’s almost like you’ve seen a cult that they’re going along with this new reality that’s been handed to them and they’re so confused that they want to fight back sometimes, but they almost feel as though they don’t know which way is up anymore. That’s gaslighting and it is honestly one of the prime pieces of artillery that a narcissist uses in a relationship.

Once the person is down, how do they get out of it?

It’s not easy at all. What ends up happening is that this term gaslighting is something that comes up in other literature like domestic violence and coercive control, people who are so beaten down in these relationships that they’ve lost their voice. Often, some of the ways we pull people out of this is returning their reality to them. As you know, doing the work you do, all trauma-informed therapy is based on validating the client’s reality. The best work that’s done with clients who’ve been gaslighted is therapists who are trauma-informed, that you let the client tell their story without judgment. You give them exercises to almost start getting acquainted with themselves. They can say, “I’m warm,” and say, “You’re warm, I can switch this thermostat.” Instead of saying, “I’m not warm.” The other person’s been gaslighted saying, “You’re right. It’s not warm.” We let the client own and be in their reality, then give them ways to practice that. You also help them build out new support networks where they are heard, seen and multiple opinions can be heard at the same time. You and I could have a conversation where I can share with you a feeling and you might say, “That’s an interesting feeling. Can you tell me more about that? That’s a hard feeling to have. It sounds like that was hard for you,” instead of you saying, “You have no right to feel that way.”

If a person has mental health issues, let’s say anxiety, bipolar depression, how does being in a relationship with a narcissist impact their mental health?

If a person has an existing mental health condition like anxiety or depression or any number of mental health issues, and they go into a relationship with a narcissist, we will see a significant exacerbation of their symptomatology. A depressed person will become significantly more depressed and may not even feel like they have the resources to fight the confused fight. An anxious person will get paralytic anxiety. A person who is living with bipolar disorder emits confusion. There could sadly even be issues with medication adherence, which could then place that client at greater risk for a manic episode.

ILBS 18 | Understanding Narcissism

Understanding Narcissism: Give yourself a year, and you will become acquainted with your rhythms and values.


There are people who go through these relationships and go on to develop significant anxiety, symptoms of depression, hopelessness, powerlessness, confusion, helplessness, rumination to the level that when they presented therapy, they do look like they have a Generalized Anxiety Disorder or PTSD or a Major Depressive Disorder. The core of it is being in one of these confusing relationships. Many times, simply educating the person about the relationship can help with that symptomatology. If a person has an existing mental health issue, one of these relationships could set them back years.

How does narcissism affect relationships and codependency?

It’s an interesting dynamic. I always tell people I’m very reluctant to initially use that term codependency when I look at a narcissistic relationship, and I’ll tell you why. Some of the issues around codependency in terms of the derivation of self-esteem by catering to the more difficult person in the relationship and often in an addiction framework doing the dance of two around the addiction, this is more in the narcissistic relationship. What we see is that one partner, the non-narcissistic or less narcissistic partner as it were, will keep making justifications for the narcissistic partner, which is a theme we see in codependency. Here’s the rub in a significant proportion of people who are living under these narcissistic relationship conditions, merely educating them on the narcissistic pattern.

Telling them, “Did you know that this is a thing and it’s never going to change?” They’re like, “What? This is never going to change?” I’m like, “No, never.” They’re like, “You’re telling me if I don’t do this or after he retires?” I’m like, “Never.” They’re like, “Thank you for telling me.” They call the attorney that night. That’s not codependency, that’s lack of information. I do think there’s a subset of clients, even armed with the information, even armed with knowing it’s not going to change, and will continue down the rabbit hole of justification, “Maybe I can try this differently, thanks. Let me go find a new therapist,” then you might see something that looks more like a codependent type of pattern where there’s such a strong trauma bond, but they cannot pull out of this problematic relationship. A pretty decent chunk of cases, once they understand what the writing on the wall is because no one told them, they’re like, “I’m getting out. I did not know this. Thanks.”

Let’s talk about the relation between narcissism and substance use disorder.

It’s high, and no pun intended, but let me tell you why that is. People who are narcissistic have a lot of trouble with regulating their emotional states, particularly when they’re stressed, frustrated, disappointed or if they feel abandoned. Under those conditions, people with narcissistic personality styles have a hard time regulating their emotions. What’s the best thing to turn to? Substances, and so they do. What we see with many narcissistic individuals is they have a natural draw to stimulants because it amps up the grandiosity. They’re already grandiose and this almost seems to make those grandiose defenses rock hard.

However, you will also see that people will use a numbing depressant type of substance or even substances like marijuana that feel like they cut through the anxiety because there’s more anxiety and narcissism than a lot of people realize. There’s a lot of social anxiety for narcissists who feel like they’re being judged socially. Because of that propensity, the likelihood for the co-occurrence of addiction and narcissism is quite high. In addiction, we see the reliance on defenses like denial and rationalization. Those defensive patterns are also very prominent in narcissistic patterns.

Narcissists may come off as charming, charismatic, and confident because of their grandiose exterior. Click To Tweet

We also see egocentricity in addiction that is also observed in narcissism. Here’s where things get dicey, especially for many families out there, they’re like, “He is such a jerk, so selfish and mean. I’m going to be glad when he goes through rehab and comes out because we’re going to get our guy back. We’re going to get our son back. We’re going to get our daughter back. We’re going to get them back.” The person goes to those 28 days, maybe they do six weeks of great rehab treatment. They come out, clean, sober, going to meetings, but they’re as much of a jerk as they always were. The narcissism tends not to go away in rehab.

One of the issues is there are a lot of rehab centers that don’t recognize narcissism that it’s all addiction all the time. By not recognizing that pattern, narcissism is going to increase the likelihood of relapse because when they’re out and even if they’re in a sober living situation, have a sober living companion, and going to meetings every day, frustration and disappointment and all that stuff is going to come into life. Life happens. Under those conditions, a person with a narcissistic personality is not going to be able to cope and they’re going to go to the quickest thing they’ve got, which are substances. If somebody is working with a narcissist who is in sobriety, what you want to do is play a little bit of a game with them and put so much pride and ego into their sobriety that they fight for it, because if you don’t make it about that, sometimes it’s hard for them to give over to a higher power because they’re grandiose enough to think that they’re that.

You are fighting a battle within Twelve-Step and that you almost need to invite their ego along for the ride, and get the ego invested in sobriety as though that’s the noble stance, and you might get some buy-in there. The families, spouses, adult children, when a person leaves rehab and they’re narcissistic, they might even be more irritable, more entitled and nastier than before because before, the substances might’ve even been masking some of the key antagonistic dynamics. It can get messy. A lot of people feel very frustrated when they see a narcissistic person who comes out of rehab and is back in their lives.

When a person gets clean and sober and they don’t do the “work” and dig deep, change their lifestyle habits, and change their behavior, they call that person a dry drunk. If a person goes to rehab, which is one of the purposes of this show, there’s more to getting clean and sober than just going to treatment and Twelve-Step meetings. How do you go about addressing the narcissism?

There has to be honesty about any mental health or addiction services practitioner working with these clients. Because addiction is often such an acute concern with the client like we want to get them safe, especially if they’re using something that’s putting their health in jeopardy, the acute need to focus centrally on the addiction and the substance or alcohol use, which totally makes sense. The challenge is that if that becomes the singular focus, that when the personality dynamics get missed, the work does need to be done in rehab around things like mindful awareness of how a person speaks to other people, the building up of self-reflective capacity on how the narcissist impacts other people, “Are you aware of how you spoke to that person? Are you aware of how other people are experiencing you? Can you please wait before you speak?”

Humility, like getting their hands dirty, inviting them into other people’s stories, and for them to be present with other people’s stories without contempt, means a well-trained staff that’s able to see through that and watch some of that narcissistic stuff play out even in their non-verbals: eye contact, engagement with the process, ability to engage in entitlement, “Let me have my phone. I could buy and sell you in one more minute.” The answer is, “No.” You might have people leaving against medical advice. You’re used to that. You’re an old pro at this. You’ve seen that entitlement. It’s about how you set that boundary and still keep people engaged.

It’s also to understand that sometimes you can’t break through the narcissistic defenses and you’re going to create whether it’s this dry drunk rubric once they leave. It’s those interpersonal dynamics. Some of them will say, “I want to stay sober because I don’t want to lose my business.” Sobriety is entirely linked to the business. It’s not the work but it’s like, “I still want to be a pillar of my community. I still want to make $1 million or $1 trillion.” It’s not about this engaging in the true deep work of Twelve-Step of getting your life back from addiction.

ILBS 18 | Understanding Narcissism

Understanding Narcissism: Even after getting sober, a narcissist can still relapse if their frustrations and disappointments continue every day.


They take the ongoing antagonistic patterns to continue and the investment in sobriety isn’t investment sobriety, it’s an investment in their business, which is all guaranteeing they’re going to not be sober at some point because the business is going to let them down. It’s not easy. However many times the average relapses post-rehab, multiply that by at least two with a narcissist, you’re going to have that many more relapses.

Is there a Twelve-Step program for narcissists?

There’s none. It’s an interesting way to think of it from the outset that they have to accept it, that this is what they’re always going to be to commit to change and making amends. A lot of the steps could be quite interesting in narcissism. The challenge is not by all means, but a substantial proportion of people who are narcissistic have no awareness that this is their pattern. When it’s pointed out to them, they may cop to it for a minute, but then immediately return to it and become barbed and difficult with anyone who tries to point it out. A lot of people say, “This isn’t even worth the fight.” Narcissistic individuals are 61% more likely to drop out of psychotherapy.

The odds of keeping them in for the long-term, especially when you start trying to drill down and do the deeper work, the first time a therapist says to them something, they don’t want to hear and pack it in and leave, and they’ll therapist jump. They’ll be dismissive of the whole enterprise, “This therapist will just take your money. They talk to you. Forget it, I can figure it out. I’d rather get a massage.” They will be very contemptuous and dismissive. It’s a defensive maneuver designed to protect them. The challenge would be though that the motivation for change is not nearly at the level you might see addiction because for a lot of these people, their narcissism is working for them. They don’t think it’s a problem. You’d see that as a majority level, rather than addiction but I think it’s an interesting thought.

They’re not happy, joyous and free, but on the outside, they look good. Maybe they’re making money, have a big house, own a business and seems to be going well for them, so that part they want to keep. They just want to stop using drugs.

That’s different in narcissism. For some of them, people will say like, “I don’t want to be a nice empathic guy. That means leaving money on the table. I don’t want to be a nice empathic person, that’s going to mean leaving money on the table or getting a worse deal.” The idea is like, “What if you got the worst deal?” It seems like the nature is you’re still walking off with a lot of money and now a lot more of the employees are going to get a better severance out of this. They’re like, “Why should they get my money?” You keep this wall that winning is important to them, that pulling them out of that un-empathic space can get challenging.

The Twelve-Step program is a program of honesty. It’s about behavior change, doing the next right thing, keeping my side of the street clean. If it is not in line with making more money, then why would they do that?

Ignoring red flags in a relationship will make you pick the same kind of person all over again. Click To Tweet

It would be a tough sell in those situations. I know that Twelve-Step programs and meetings are very much user-led and user-guided. That feels like the foxes in charge of the henhouse. I don’t even know who’s going to run that meeting. Bless their hearts.

I’m a grateful recovery narcissist.

If they’re recovered narcissists, they are like, “I don’t want to be in a room with all you all.”

Are there some treatment centers that are geared more for people that are narcissists?

In terms of psychiatric?

An inpatient treatment center for somebody that’s an alcoholic or drug addict, but it’s like, “All the narcissists should go to this one,” or are they the more expensive one?

If anyone figured this one out, a treatment program, I don’t think it could be a 28-day, it would have to be longer, that was able to master the narcissism alongside the addiction, it would be worth its weight in gold. Some people proclaim to do it, but I don’t think they’re doing it. This isn’t the fault of the treatment centers. My read on the literature is that there’s absolutely nothing convincing in the narcissism treatment literature that shows long-term efficacy. What happens is that even in the scientific literature on the treatment of people with Narcissistic Personality Disorder, it tends to be researched on very small samples. Sometimes it’s more like case reports. You can’t generalize from case reports. These are often courses of therapy that last 12 to 18 months, 2 to 3 times a week. I don’t know many people in the United States of America that can afford therapy with a highly-trained therapist, 2 to 3 times a week, and stay in for 12 to 18 months. That is available to less than 1/10 of the population.

Granted rehab is much more condensed so you’ve got the person around the clock, so it’s not outpatient extended for a year. You’re talking about someone specifically trained in these specific models and work at them while you’re still trying to manage sobriety. It’s a tall order. You need a uniquely motivated client, and then you need outside of that one heck of an outpatient therapist to work with them in perpetuity. That set up is almost impossible to achieve. I suppose if you had all of that, then sure. It’s a silly thing to proclaim. That’s like seeing if you moved a personal trainer, a personal chef and a personal something else in my house, I’d lose weight and I’d look like $1 million, I’m sure I would. I don’t have those things. It’s the same thing here.

ILBS 18 | Understanding Narcissism

“Don’t You Know Who I Am?”: How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility

The other thing is that they would have to want it.

My point is even if they want it, without that pristine top-drawer level of treatment, the first time frustration or disappointment or abandonment or stress crosses their path, they’ll snap. It means then that you create a life that doesn’t have those things in it. I don’t know what that means, it’s like living in some strange bubble.

In your experience, are there certain addictions that narcissists are more prone to?

They’re equally prone to all addictions because addictions at the core are regulatory deficits. The desire to regulate with something outside of the organism rather than to self-regulate. Drugs and alcohol are going to top the list, but people who have Narcissistic Personality Disorder struggle a lot with gambling addiction, spending addiction, spending and acquiring shopping, they struggled with food and you’ll see co-located with eating disorders or at least very dysregulated eating behavior, either like extremes of starving for reasons of looking a certain way, getting almost obsessive-compulsive, “I’ll only eat this and that in a very certain way.” It’s over-controlled to almost offset the chaos of narcissism. You see a whole host of dysregulated patterns that will sit alongside narcissism, and often more than one.

Dr. Ramani, how can people learn more and find out more about you?

The best place to go is my website, If you go there, you’ll see links to everything that I do and the workshops I do. The other place I’d suggest to people is to go to my YouTube channel which is DoctorRamani. That is a trove of hundreds of videos on narcissism as it relates to families, relationships, workplace, why narcissists do the things they do? Why do survivors of these relationships do the things they do? All of that is there in a massive library of videos that you can look at, at no cost. There are lots of different ways. I have two books but all of that information is on my website.

Her YouTube channel is amazing. She’s got hundreds of videos that are awesome. Dr. Ramani, thank you so much. Thanks, everybody, for reading.

Important Links:

About Dr. Ramani Durvasula

Dr. Ramani Durvasula is a licensed clinical psychologist in Los Angeles, CA and Professor of Psychology at California State University, Los Angeles. She is also a Visiting Professor at the University of Johannesburg. Additionally, she is the founder of LUNA Education, Training & Consulting, LLC, a company focused on providing content and education about high conflict and antagonistic personality styles such as narcissism and their impact on mental health, relationships, families, and the workplace.

Dr. Durvasula is also the co-founder of the Narcissistic Abuse Awareness Alliance, a collaborative professional group of therapists and coaches working with clients experiencing these relationships. She takes on entitlement and incivility in “Don’t You Know Who I Am”: How to Stay Sane in the Era of Narcissism, Entitlement and Incivility. She is the author of the modern relationship survival manual Should I Stay or Should I Go: Surviving a Relationship With a Narcissist, and of You Are WHY You Eat: Change Your Food Attitude, Change Your Life. She also has a popular YouTube channel that focuses on narcissism and difficult relationships.

The focus of Dr. Durvasula’s clinical, academic and consultative work is the etiology and impact of narcissism and high conflict, entitled, antagonistic personality styles on human relationships, mental health, and societal expectations (and vice versa!). Her work has been featured at SxSW, TEDx, and on a wide range of media platforms including Red Table Talk, the Today Show, Oxygen, Investigation Discovery, Bravo, and she is a featured expert on the digital media mental health platform MedCircle. Dr. Durvasula’s research on personality disorders has been funded by the National Institutes of Health and she is a Consulting Editor of the scientific journal Behavioral Medicine.

Dr. Durvasula is an honest, authentic, and brutally honest voice on the struggles raised by narcissism in the US and globally.

Forging Your Own Path in Recovery

The only person you are destined to become is the person you decide to be.”
-Ralph Waldo Emerson, American writer, and philosopher

We all have choices. We all made decisions that led us to become the people we are today. Therefore, we can make decisions to move us closer to becoming the people we want to become. The choices we make shape our days and our days shape the course of our lives.

These choices can be simple, like deciding what we will have for breakfast and what we will wear for the day. Conversely, our decisions can be more complex, like choosing a romantic partner or picking a career path. For individuals in recovery from mental health, substance use, and/or alcohol addiction, choosing a treatment program is vital to implementing and maintaining the lifelong recovery habits needed to stay healthy. Fortunately, there are countless treatment resources available. This means that you have options and can be empowered to make a decision based on your needs, goals, and lifelong dreams.

Limited Options in the Early Days of Recovery

In the early days of mental health and addiction recovery, clients’ treatment options were few and far between. The 19th century and early 20th century utilized mass institutes for “one size fits all” treatment. Therapy was generally reserved for the wealthy classes and limited to years and years of psychoanalysis.

In other words, therapy during these times still looked like that old stereotype of a detached, bearded doctor sitting on a chair scribbling notes as the patient lies on the couch, sharing the inner workings of their minds in narrative form. Soldiers were returning home from World War I with “shell shock,” or Post Traumatic Stress Disorder (PTSD).

They had virtually nowhere to turn to for help, as mental health treatment was expensive and options were lacking. Many of them turned to alcohol and/or substance abuse to cope. Fortunately, 12-step programs emerged to help people abusing alcohol and/or other substances manage their addictions.

Similar to today, these programs were structured by meeting attendance and working the 12-steps with a sponsor. These programs continue to be a popular treatment today and have proven to be useful for many people. The ideas in 12-step programs have created the foundation for the more open and inclusive concept of “recovery” in the treatment of addiction and mental illness.

What is “Recovery?”

What do you think of when you hear the word “recovery?” For some, quite a few concepts and approaches might come to mind. However, those that have never heard the term applied to mental health and addiction will likely think of recovery in terms of physical ailments. Perhaps your mind goes to the idea of getting rest to recover from a bout of the flu, or maybe you think of recovering from a broken bone with a cast and physical therapy.

Can the same term be applied to mental health, trauma, and addiction? Yes! After all, people suffering from these issues require healing as well. Recovery from mental illness and addiction varies in approach from person-to-person. Recovery is best approached as an individualized journey, and many innovative programs have created treatment choices to empower their clients to make their recovery work for them. Here are some recovery treatment modality choices that may be new to you:

  • Canine Therapy
  • Peer Support and Peer Mentoring
  • Brain-Body Approaches
  • Wilderness Therapy
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Brainspotting
  • Resilience Training
  • Group Therapy
  • Mindfulness
  • Art and Music Therapy
  • Acceptance and Commitment Therapy (ACT)
  • Cognitive Behavioral Therapy (CBT)
  • Dialectical Behavioral Therapy (DBT)
  • Rational Emotive Behavioral Therapy (REBT)
  • And many more choices for your recovery journey!

We Have Come a Long Way

Things are not nearly as limited as they once were. Having choices makes us feel more empowered and less hopeless when beginning recovery. For example, imagine that you were buying tires for your car, and there was only one store selling one brand. How would you feel?

You would not have a choice! You would have to pay whatever they were charging, and you would have no options for road conditions you may encounter. Chances are, that would not make you feel very empowered as a consumer. Choices in recovery work the same way.

They allow you to truly personalize your recovery journey and try various options until you find something that works! To paraphrase the quote above from Ralph Waldo Emerson, you become the person you decide to be. By having treatment options, you have more decision-making power and become empowered to carve a path that will work for you!

We have come a long way in the treatment of mental health disorders, alcohol abuse, and substance dependency. Recovery continues to grow in terms of treatment options and resources. Additionally, the stigma associated with addiction decreases as people like you take steps to pave the way for others with similar struggles. Continue to forge your path. Make the best decisions for your recovery and become the person you were destined to be!

Recovery is an extremely personal process, and it takes time to discover your own path. Still, every recovery journey begins with a single step: admitting that you need help. At Camelback Recovery, you’ll find a sober living community ready to provide you with the tools you’ll need on the journey to sobriety. If you’re ready to get sober, it’s time to lean on the experience and strength of others who have come before you. Sobriety is not as uncharted as it may seem. Through a holistic recovery program, you can heal spiritually, mentally, and physically – you just need the time to do so. At Camelback Recovery, you’ll find the community you’re looking for and the experienced guidance you need. Give us a call at (602) 466-9880. Getting sober isn’t easy, but it can be an exciting period of your life, filled with transformational experiences and incredible growth.

Substance Use in the Community

Which of the risk factors for substance use are present in your community of origin, or a community in which you currently live or work? Are there other factors that were left off the list?

An online search was conducted regarding risk factors for substance use, which are present in my community of origin. A youth survey was found for the State of Louisiana, Parish of Caldwell, of which I reside. The Louisiana Caring Communities Youth Survey Results for 2008 presents some information for Caldwell Parish regarding risks factors that consist of the main categories of demographics, social, behavioral, and individual. The chart given in the results of the youth survey involved the risk factors of community, the family system structure, school, and peer/individual, with demographics presented involving certain age groups of adolescents (Louisiana Department of Health and Hospitals, 2008). However, there were no demographics regarding gender given in this article. The information reveals that economic and social problems exist, which contribute to the substance abuse problem within the parish community. The community also suffers from a disorganized community structure that is causing a detachment in the neighborhood. This community a small rural area with very little funding for substance abuse prevention and treatment, which is a major concern for our community as the drug problem continues to escalate. The article shows that family problems exist within the community such as conflict and management of the family structure. Problematic behaviors in our parish such as alcohol and drug abuse are prevalent among the adolescent population. Such behaviors are family-oriented as many parents of the adolescents within this community are abusing substances. The Louisiana Department of Health and Hospitals (2008) also presents some evidence that show problems in the school system such as a lack of commitment, behaviors of an antisocial aspect, and failure in academic achievement, which contribute to substance abuse (p. 4). These problematic behaviors contribute to a high dropout rate. When examining the peer/individual risk factor listed in the youth survey, it shows that peer pressure is high with a favorable attitude toward using substances. Also, the information reveals that rebellion and withdrawal is a contributing factor to the drug use in my community. This information shows a strong need for more education and a greater awareness of the need for more funding and interventions before our community erodes even further.

There are other factors that interfere, which are not listed in this information. However, I have personally witnessed them, such as politics. This is a very political community that unfortunately, makes money off of our youth and adults who are using drugs by charging fines and putting them back on the street with no form of rehabilitation. As a past advocate for helping those abusing drugs, I witnessed the court system charge individuals $500.00 each and place them on probation for six months, knowing that these individuals would be arrested again so that $500.00 more could be charged. This is a major problem within our local court system.

Also, our local mental health behavioral health clinic does not have anyone on staff with a college degree other than a lady who represents a whole district of parishes. Most of her time is spent traveling from one clinic to another. While in a bachelor’s degree program, I wanted to take a class that required that I spend some time at a local facility to learn about how to conduct group counseling sessions. When I contacted this particular facility, I was told that they were too busy. This proves that our local parish has a disorganized structure, as indicated in the youth survey that was reviewed.



Louisiana Department of Health and Hospitals. (2008). The Louisiana caring communities youth survey results for 2008. Retrieved from

Substance Abuse – What is the Therapeutic Index?

The text (pg. 108) describes the phenomenon of “therapeutic index.” Addiction to barbiturates can be critical in terms of lethality as measured by the therapeutic index. Provide an example, which explains how this phenomenon might lead to an accidental overdose. Why is this factor more critical with barbiturates than with other classes of depressant drugs?  For follow-up discussion, respond to at least two of your peers.


The therapeutic index is the lethal dose for 50% of mice/the effective dose for 50% of the mice. Because the lethal does should always be higher than the effective dose, the therapeutic index should always be higher than 1 (Hart, 2012). The higher the therapeutic index, the safer the drug is. For example, valium can have a therapeutic index of 770. That means that a person would have to take 770 times the amount it would take for sedation in order to take a lethal dose.


Barbiturates alter central nervous system activity. According to Barbiturates Overdose, barbiturates have a very narrow therapeutic range. In other words, the drug can be dangerous if you take an amount not much greater than the standard dosage amount (Barbiturate Overdose, 2013). This makes it much easier to overdose.


For example, let’s say a person takes a Nembutal to calm his anxiety down. He also has a couple of drinks. Then he is still feeling anxious so he takes another Nembutal. Then without giving the Nembutal enough time to kick in, he takes another four because he is impatient and wants it to start working. The standard dosage was one pill and he took six. This was six times the standard dosage amount and the therapeutic index was six. This leads to an overdose.




Barbiturate Overdose. (2013). Retrieved from


Hart, C. L., & Ksir, C., (2012). Drugs, society, and human behavior (15th Ed.). New York, NY: McGraw-Hill. Retrieved on February 28, 2015

Substance Abuse Screening Instruments

There are numerous screening instruments available to help counselors assess and diagnosis substance use disorders. What are the advantages and disadvantages of using standardized instruments to assess and diagnose clients?

There are several advantages and disadvantages of using standardized instruments to assess and diagnose clients. Because information gathered from a standardized test can be compared to the normal population, a counselor can use the information as part of the clinical decision making process. The information can also be useful when working with a client that is in denial or is in resistance to their substance abuse addiction. For example, a client could debate that drinking a liter of vodka per day is normal because his parents both drink a liter of vodka per day. However, compared to the normal population, drinking a liter of vodka per day is a strong indication of alcoholism. Data gathered from a standardized test has the benefit of objectivity. A client cannot accuse a counselor of being biased or opinionated just because he wants the client to go to treatment because that is how he gets paid. Substance abuse addicts often minimize their drug use. Therefore, there are standardized tests which indirectly screen individuals for substance abuse. (Capuzzi, 2012). Standardized tests are good for many reasons as mentioned. However, a standardized test cannot be customized to better suit the needs clients. Standardized test can also become outdated.  


Capuzzi, D., & Stauffer, M. (2012). Foundations of Addictions Counseling. Upper Saddle River, NJ; Pearson Education.

Group Design-Adults with a Substance Abuse Condition (cont’d)

Transitioning to Closure

There are several tasks that will need to be accomplished with a member that will be terminating membership of an open group. First, members of the group should fully understand how to give notice and what steps need to be taken in order to appropriately terminate themselves from the group. Second, the member that is leaving will need adequate time to prepare emotionally for their departure. Next, other members of the group should have the opportunity to say goodbye. Different cultures view endings differently, and this should be taken into consideration. Lastly, a final individual session or follow-up call should be discussed and potentially scheduled. The group leader will need to get consent for this final session or phone call. Specifically, the group leader will want to review what the member learned during group counseling and how he will implement those things into his life moving forward. Referrals will be made when appropriate (Corey, Corey, & Corey, 2010).

Adults with a Substance Abuse Condition (Cont’d)

Third and Fourth Sessions

Checking in with the members of the group kicks off the third session. During the check-in, one of the members, Jesse stated: “I am not feeling very good about myself today.”

Group Leader: “Do you want to tell us why you are not feeling good about yourself today?”

Jesse: “Not really.”

Group Leader: “Jesse we are here for you and we want to support you. We can only support you if you are open and honest with us. Tell us what is going on?”

Jesse: “I used meth over the weekend. I put myself in a vulnerable situation and I relapsed.”

Group Leader: “Ok, do you want to share with us what happened?”

Jesse: “I went out on Saturday night with a few of my friends. We ended up at a party and before I knew it, I was high!”

Group Leader: “Does anyone have anything to say to Jesse?”

Jackie: “Jesse what were you thinking? You should have called me. I told you that I would be here for you if you were ever in a vulnerable situation!”

Jesse: “I know Jackie, I think that deep down I knew that I was going to come across meth if I went out with my friends.”

Jackie: “Why do you think that you put yourself in that situation?”

The group leader’s responsibility was to dig deeper and find out what was bothering Jesse. After further questioning, Jesse opened up and shared to the group that he had relapsed. The members of the group must be willing to share and be open with the group in order to have meaningful interactions with other members (Corey, Corey, & Corey, 2010). Jesse getting honest with the group continues to build group cohesion. Jackie stepping in and offering support shows that group cohesion is getting stronger.

Also during the check-in, another member, Michelle stated, “I was sexually abused as a child.”

Group Leader: “Do you want to share with us what happened?”

Michelle: “When I was 13 years old, my uncle Tom sexually abused me. He used to take care of me when my parents were out of town. He would get drunk and sexually abuse me.”

Group Leader: “I am really sorry to hear that Michelle. How are you feeling right now?”

Michelle: “I’m angry!”

Jackie: “I was also sexually abused as a child, so I can relate. I too was angry. I did not trust men until I finally was able to work through the trauma.”

Michelle: “How were you able to work through the trauma?”

There are many fears that the group members could potentially have including the fear of being vulnerable, the fear of rejection, the fear of self-disclosure, or the fear of being judged (Corey, Corey, & Corey, 2010). Michelle opening up and sharing such a thing shows that she is feeling trusting and comfortable with the group. It is the group leader’s job to make Michelle feel safe, to fully recognize what happened to her, and to assist her in working through the event (Corey, Corey, & Corey, 2010). Depending on how severely Michelle is affected, it might be best to refer her to individual therapy to work through this traumatic event.

The third session closes with homework being given, to complete a Relapse Prevention Plan, which will be due in one week.

During the fourth session check-in, Mike states, “I got wasted at the game on Sunday. Not only did I get wasted, but I also drove home.”

Group Leader: “Wow Mike! That came out of the blue. Do you want to share with the group what happened?”

Mike: “I went to the game with a bunch of guys from work, and they were all drinking. I didn’t want to tell them that I didn’t drink. Therefore, I thought it would be okay to have a couple of beers. Next thing you know, I was wasted. I drove home after the game because I did not want to have to call my wife to come and pick me up.”

Group Leader: “So how are you feeling about yourself right now?”

Mike: “I feel like a loser. I let myself down, I let my wife down, and I let you guys down.”

Group Leader: “Mike we are here to support you and love you. Does anyone else want to say anything to Mike?”

Jesse: “Mike, I am here to support you in anyway that I can. I wish that you would have called me prior to taking that first drink.”

Jackie: “You could have called me Mike. I would have given you a ride home.”

Michelle: “How were you feeling prior to the game? What was going on that you were in a vulnerable place?”

The group leader’s job is to provide a balance between confrontation and support. It is the group leader’s job to support Mike in taking a risk and opening up to the group. Getting him to reflect on his behavior will promote a deeper level of self-exploration (Corey, Corey, & Corey, 2010). The members of the group want to love an support Mike as well. The group leader does a good job getting the members of the group to speak up.

Group Design-Adults with a Substance Abuse Condition (cont’d)

Second Session

Because the group will composed of recently clean and sober adults, it is going to take more than one full session for the level of trust and comfort to be at a place where productive group work will take place (Jacobs, Masson, Harvill, & Schimmel, 2011). During the first part of the second session, the beginning stage will come to an end as the trust and foundation of the group are still being formed. An activity designed for the members to get to know each other individually will be next. The group will break up into dyads, and select a new partner every 10 minutes. Questions asked of each member will include:

  • Why do you want to be clean and sober?
  • What do you expect to get out of the group counseling experience?
  • What is your biggest fear about the group counseling process?
  • What is your level of trust in the group? What is contributing to your trust or mistrust?

During this session, one of the members, John stated: “I am uncomfortable being with groups and I really do not want to be here.”

In response to this statement, this writer herein described as Group Leader stated: “John, tell me more about why you are uncomfortable being with a group?”

John: “I do not know the other members of this group. Why would I want to open up and share with complete strangers?”

Group Leader: “If you got to know the other members of the group, would you feel comfortable being in this group and would you want to be here?”

John: “I guess so.”

Group Leader: “Does anyone else have anything to say to John?”

Jackie: “You and I have had several conversations and I feel comfortable opening up to you. I have learned from you and I think that you are an important member of this group.”

Michelle: “I think that you are an important member of this group and I too am glad that you are here.”

Group Leader: “What do you think about that John?”

John: “Wow, I had no clue. Knowing that other members of the group like me makes me feel more comfortable already.”

It is important here to get John to open up and express how he is feeling and what he is thinking. This will promote group cohesion and trust will start to be established if the facilitator can get him to share (Corey, Corey, & Corey, 2010). Getting other members of the group involved in the discussion helps John see that he is an important part of the group and it makes him feel more comfortable.

Checking in with all of the group members closes the session.

Group Design – Adults with a Substance Abuse Condition

Group Goals

There are many goals that I can think of that individuals with a substance condition might have. However, I have narrowed the list down to five goals:

  1. Each member will confront difficult issues in his life and learn a technique to handle the issues more effectively.
  2. The members of the group will provide a supportive network for the other members of the group. Members of the group will support each other by listening, caring, opening up.
  3. The members of the group will learn more effective ways to handle difficult social situations. Difficult social situations will be discussed during the sessions.
  4. Each member will complete a relapse prevention plan and share it with the group.
  5. Members of the group will provide constructive feedback to other members of the group.