Substance abuse and dependence (alcoholism, drug addiction) is only one form of recurrent and self-defeating pattern of misconduct. People are addicted to all kinds of things: gambling, shopping, the Internet, reckless and life-endangering pursuits. Adrenaline junkies abound.

The connection between chronic anxiety, pathological narcissism, depression, obsessive-compulsive traits and alcoholism and drug abuse is well established and common in clinical practice. But not all narcissists, compulsives, depressives, and anxious people turn to the bottle or the needle.

Frequent claims of finding a gene complex responsible for alcoholism have been consistently cast in doubt. In 1993, Berman and Noble suggested that addictive and reckless behaviors are mere emergent phenomena and may be linked to other, more fundamental traits, such as novelty seeking or risk taking.

Psychopaths (patients with Antisocial Personality Disorder) have both qualities in ample quantities. We would expect them, therefore, to heavily abuse alcohol and drugs. Indeed, as Lewis and Bucholz convincingly demonstrated in 1991, they do. Still, only a negligible minority of alcoholics and drug addicts are psychopaths.

What has been determined is that most addicts are narcisstic in personality. Addictions serve his purpose. They place him above the laws and pressures of the mundane and away from the humiliating and sobering demands of reality. They render him the center of attention - but also place him in "splendid isolation" from the maddening and inferior crowd.

Such compulsory and wild pursuits provide a psychological exoskeleton. They are a substitute to quotidian existence. They afford the narcissist with an agenda, with timetables, goals, and faux achievements. The narcissist - the adrenaline junkie - feels that he is in control, alert, excited, and vital. He does not regard his condition as dependence. The narcissist firmly believes that he is in charge of his addiction that he can quit at will and on short notice.