Trump specifically seems to hew awfully close to the symptoms of a long-term cocaine user. The hard drift into self-congratulatory vanity parallels that of Charlie Sheen during a certain infamous interview, for example, and at least two people (Howard Dean and Carrie Fisher) identified him as having compulsive sniffing reminiscent of a cocaine habit during debates prior to his first election.

Remember that Trump is not a first-generation member of the upper class; as a nepo baby, he was born out of touch and has spent his whole life falling deeper into bizarre social bubbles and media silos that were tailored by his ancestors and peers to reassure them that they're doing the right thing. In theory plutarchs should be receiving world-class education from private tutors, but being arch-Conservatives by definition, these teachers are invariably out of date on mental health, and would be forbidden from teaching it even if they had modern material.

Because of this isolation the ultra-wealthy often have certain very uneducated traits around self-esteem—which can paradoxically seem like the result of poverty. They do not have access to DARE or Sesame Street to give them the confidence not to take drugs when pressured, they've never seen Mister Rogers, their biological parents were always off running a business empire, and they have no surrogate figures because their nannies probably get fired at the drop of a hat, even for defending the child's interests.

Ironically, American republicanism makes this worse; in a planned aristocracy, parents internalize the belief that their children deserve "the best" because they are meant to be "the best", but without that noble lie, there is no pressure to create a positive environment for the next generation of tyrant. To make matters worse, these families never start off with healthy values to begin with—which produces a founder effect of regressive masculinity that magnifies everything else I've just mentioned.