The difference between Selfishness and Self-Centeredness.

Projection: Attributing one’s unacceptable feelings or desires to someone else. For example, if a bully constantly ridicules a peer about insecurities, the bully might be projecting his own struggle with self-esteem onto the other person.

Denial: Refusing to recognize or acknowledge real facts or experiences that would lead to anxiety. For instance, someone with substance use disorder might not be able to clearly see his problem.

Repression: Blocking difficult thoughts from entering into consciousness, such as a trauma survivor shutting out a tragic experience.

Regression: Reverting to the behaviour or emotions of an earlier developmental stage.

Rationalization: Justifying a mistake or problematic feeling with seemingly logical reasons or explanations.

Displacement: Redirecting an emotional reaction from the rightful recipient to another person altogether. For example, if a manager screams at an employee, the employee doesn’t scream back—but the employee may yell at her partner later that night.

Reaction Formation: Behaving or expressing the opposite of one’s true feelings. For instance, a man who feels insecure about his masculinity might act overly aggressive.

Sublimation: Channelling sexual or unacceptable urges into a productive outlet, such as work or a hobby.

Intellectualization: Focusing on the intellectual rather than emotional consequences of a situation. For example, if a roommate unexpectedly moved out, the other person might conduct a detailed financial analysis rather than discussing their hurt feelings.

Compartmentalization: Separating components of one’s life into different categories to prevent conflicting emotions.

There have been various theories and models proposed over time to help us understand why individuals use alcohol and other drugs, and why some people become dependent or ‘addicted’ but not others. The following are several models or theories of addiction. They reflect the political, medical, spiritual, and social forces of those times in history.

The Moral Model

Alcohol and tobacco was introduced in the Western countries during the 1500’s. The widespread use and misuse of chemical substances resulted in a range of social problems and it was thought by some that substance use was “problematic” and “morally wrong” (Lassiter & Spivey, 2018). The moral model viewed AOD dependency as a moral and personal weakness that involved a lack of self-control, and was often viewed as a potential danger to society (Stevens & Smith, 2014).

The moral model considered addiction a “sin” and a result of free, yet irresponsible, choice. Therefore, many politically conservative groups, religious groups, and legal systems tended to punish the individual who uses AOD. The moral model or attitude towards addiction can still be seen today in certain cultures. Those who still believe addiction is morally “wrong” tend to perceive the most appropriate way to treat the individuals who use AOD are through legal sanctions, such as imprisonment and fines. For example, in many countries, drivers who are caught under the influence of alcohol or other drugs are not considered for treatment programs but instead receive court sentences as punishments (Fisher & Harrison, 2017).

This model has been rejected by alcohol and other drugs professionals as unscientific and contributes to the stigma surrounding addiction and substance use (White, 1991, cited in Fisher & Harrison, 2017).

The Disease Model

This model takes up the medical viewpoint and proposes addiction as a disease or illness that an individual has. It proposed that addiction is a disease that is progressive and chronic whereby the individual holds no control as long as the substance use continues. In other words, their addiction will continue to deteriorate with the continuous AOD (Thombs & Osborn, 2019). It also proposes that individuals who uses AOD can never be cured from addiction, though it can be readily treated through sustained abstinence such as self-help fellowships and treatment community. 

In the 1940s, Jellinek proposed a disease model in relation to alcoholism, arguing that it is a disease caused by a physiological deficit in an individual, making the person permanently unable to tolerate the effects of alcohol (Stevens & Smith, 2014). Jellinek identified signs and symptoms and clustered them into stages of alcoholism, as well as progression of the disease, which form the basis of 12-step or Anon-type programs (e.g., Alcoholics Anonymous and Narcotics Anonymous; Stevens & Smith, 2014). 

Under the disease model, treatment requires complete abstinence. Once an individual has accepted the reality of their addiction and ceased substance use, they are labelled as being in recovery, but are never ‘cured’ (e.g., “Once an alcoholic, always an alcoholic”; Thombs & Osborn, 2019). Whilst originally applied to alcohol dependency, it has now been generalised to other substances and many traditional substance use treatment models are based on this model (Capuzzi & Stauffer, 2020; Stevens & Smith, 2014).

The disease model offered an alternative to the moral theory, helping to remove the moral stigma attached to addiction and replacing it with an emphasis on treatment of an illness (Capuzzi & Stauffer, 2020). Disease theory helped to explain how some people experience the physiological effects of addiction such as dependence, tolerance, and withdrawal more than others, and how these mechanisms are caused by a biochemical abnormality in an individual which increases their likelihood of developing a dependency (DiClemente, 2018). 

While the disease model was well received by a range of professionals, many criticised it because research did not find that the progressive, irreversible progression of addiction through stages always occurs as predicted (Capuzzi & Stauffer, 2020). Additionally, many in the AOD field argued that the model did not address the complex interrelated factors that accompany dependency (Stevens & Smith, 2014). Finally, some professionals argued that the concept of addiction being a disease may also convey the impression to some individuals that they are powerless over their dependency and/or not responsible for the consequences of destructive addictive behaviours, which can be counteractive to treatment (Capuzzi & Stauffer, 2020).

Genetic and Neurobiological Theories

These theories suggest that some people may be genetically predisposed to develop drug dependency. For example, individuals usually begin substance use on an experimental basis. They then continue using because there is some reinforcement for doing so (e.g., a reduction of pain, experience of euphoria, social recognition, and/or acceptance, etc.). Some people may continue to use substances in a controlled or recreational manner with limited consequences while others progress to non-medical use and eventually develop a dependency. Why? Genetic and neurobiological theories propose that this is the result of a genetic predisposition to drug dependency (Fisher & Harrison, 2017). 

Factors being considered by researchers in the genetic transmission of dependency on alcohol include neurobiological features such as an imbalance in the brain’s production of ‘feel good’ neurotransmitters or in the metabolism of ethanol, which is the key component of alcohol (Stevens & Smith, 2014). Other researchers explored genetic differences in temperament and personality traits which they argued may lead to certain individuals becoming more vulnerable in the face of challenging environmental circumstances, leading to AOD use (Stevens & Smith, 2014). Genetic predispositions such as these may explain why some individuals develop dependency on AOD while others in similar situations do not.

The Psycho-dynamic Model

This model proposes that substance use may be due to an unintentional response to some difficulties that an individual experienced in their childhood. This explanation is based on the theory that was put forward by Sigmund Freud, whereby the problems of whether we are able to cope with difficulties as adults are linked to our childhood experience. Many counselling approaches today are based on this theory which aim to seek understanding of people’s unconscious motivations and to enhance how they view themselves (Capuzzi & Stauffer, 2020).

The Psycho-dynamtic model also believes that AOD use is often secondary to a primary psychological issue. In other words, alcohol and other drugs is a symptom rather than a disorder, and AOD use is a means to temporarily relieve or numb emotional pain. For example, an individual suffering from depression might self-medicate with stimulants to relieve the enervating effects of depression or manage their anxiety by using benzodiazepines (Fisher & Harrison, 2017). 

There is evidence to support this model, whereby childhood traumatic events are associated with mental health problems and substance use disorders. Wu et al. (2010) conducted a study among 402 adults who were receiving substance use disorder treatments. They revealed that almost all (95%) of the participants experienced one or more childhood traumatic events, and 65.9% of them experienced emotional abuse and neglect from their childhood. The authors also reported that the higher the number of childhood traumatic events experienced, the higher the risk of substance use disorders and mental health problems such as post-traumatic stress disorder. 

Personality Traits

Some theorists suggest that certain individuals have certain personality traits that are linked to AOD dependency. For example, dependency on alcohol has been associated with traits such as developmental immaturity, impulsivity, high reactivity and emotionality, impatience, intolerance, and inability to express emotions (Capuzzi & Stauffer, 2020).

Social Learning Model

This model suggests that social learning processes such as observing other peoples behaviours (i.e., modelling) and cultural norms are important in the process of learning behaviours. Albert Bandura proposed Social Learning Theory which would argue that substance use is initiated by environmental stressors or modelling people around you with “perceived status”. For example, a child observes their parents use alcohol in social situations and the child is therefore more likely to perceive that AOD use for social situations is appropriate (Harrison & Fisher, 2017); the association between socialisation and alcohol has been established.

The social learning model also recognises the influence of cognitive processes such as coping, self-efficacy, and outcome expectancies. Some researchers are currently focusing on how an individuals expectation of the effects of drugs influence the pattern of AOD use and resulting dependency. Russell (1976, cited in Wise & Koob, 2013) suggested that dependency on substance is not only chemical (biological) but also behavioural and social in nature. 

It has also been suggested that substance use occurs when an individual thinks substance use is a coping mechanism. This can be learned from television and film, social medial, peer influence, or messages from caregivers during childhood. The individual hopes the AOD use will relieve from them from stress (Stevens & Smith, 2014). 

Socio-cultural Model

Different from the previous models, the socio-cultural model perceives substance use as an issue of society as a whole instead of focusing only on the individual. People tend to overestimate the influence of internal and psychological factors while underestimating the external and environmental factors, even among some alcohol and other drugs workers (Gladwell, 2000, cited in Lewis, Dana, & Blevins, 2015). Thus, this model highlights the importance of how society shapes substance use behaviours, such as cultural attitudes, peer pressures, family structures, economic factors, and more (Bobo & Husten, 2000). For example, Coffelt et al. (2006) found that parents’ alcohol use are associated with their children’s drinking behaviour, whereby when the adult’s alcohol problems increased, the likelihood of their adolescent child’s alcohol use increased. 

The Biopsychosocial Model

Substance use behaviour cannot be explained or understood scientifically or spiritually based on a single variable, antecedent, or “cause”. Biological, psychological, learning, social and cultural context all contributes to explaining why addiction develops and maintains. The interactions between these factors are presented in The Biopsychosocial Model – arguably the most commonly used model to explain addiction today. The model suggests that substance use and the progression of substance dependency can be explained by recognising that the body and mind are connected within a social and cultural context (Skewes & Gonzalez, 2013).

The model allows any combination of biological, psychological, social and cultural factors to contribute to AOD misuse and dependency, rather than a single dominating factor. This is much more holistic and integrative when attempting to understand the determinant of addiction (Stevens & Smith, 2014).

References:

1. Bobo, J. K., & Husten, C. (2000). Sociocultural influences on smoking and drinking. Alcohol Research and Health, 24(4), 225-232. 
2. Capuzzi, D., & Stauffer, M. D., Sharpe, C. W. (2020). History and etiological models of addiction. In D. Capuzzi, & M. D. Stauffer (Eds.), Foundations of addictions counseling (pp. 1-22). Pearson Education.
3. Coffelt, N. L., Forehand, R., Olson, A. L., Jones, D. J., Gaffney, C. A., Zens, M. S. (2006). A longitudinal examination of the link between parent alcohol problems and youth drinking: The moderating roles of parent and child gender. Addictive Behaviours, 31, 4, 593-605. https://doi.org/10.1016/j.addbeh.2005.05.034 
4. DiClemente, C. C. (2018). Addiction and change: How addictions develop and addicted people recover. The Guilford Press.
5. Fisher, G. L., & Harrison, T. C. (2017). Substance abuse: Information for school counsellors, social workers, therapists, and counsellors. Pearson Education. 
6. Lassiter, P. S., & Spivey, M. S. (2018). Historical perspectives and the moral model. In P. S. Lassiter, & J. R. Culbreth (Eds.), Theory and practice of addiction counselling. (pp. 27-46). Sage Publications. 
7. Lewis, J. A., Dana, R. Q., & Blevins, G. A. (2015). Substance abuse counselling. Cengage Learning.
8. Skewes, M. C., & Gonzalez, V. M. (2013). The biopsychosocial model of addiction. In P. M. Miller, A. W. Blume, D. J. Kavanagh, K. M. Kampman, M. E. Bates, M. E. Larimer, N. M. Petry, P. D. Witte, S. A. Ball (Eds.), Principles of addiction: Comprehensive addictive behaviours and disorders (pp. 61-70). Academic Press.
9. Stevens, P., & Smith, R. L. (2014). Substance abuse counselling: Theory and practice. Pearson Education. 
10. Teesson, M., Hall, W., Proudfoot, & Degenhardt, L. (2012). Addictions. Taylor & Francis Group.
11. Thombs, D. L., & Osborn, C. J. (2019). Introduction to addictive behaviours. The Guilford Press. 
12. Wise, R. A., & Koob, G. F. (2013). The development and maintainance of drug addiction. Neuropsychopharmacology, 39, 254-262.
13. Wu, N. S., Schairer. L. C., Dellor, E., & Grella, C. (2010). Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addictive Behaviors, 35(1). 68-71. https://doi.org/10.1016/j.addbeh.2009.09.003 

Picture a runaway trolley hurtling down a track. Five people are tied to the rails ahead. On a side track, there is one person — a child. You are standing at the lever. Pull it, and the child dies. Leave it, and five adults are killed. What do you do?

This is the Trolley Problem — a thought experiment introduced by philosopher Philippa Foot in 1967 and endlessly debated ever since. It seems, at first glance, like a maths question dressed up in moral clothing. But the more honestly you sit with it, the more it reveals about something far deeper: what we actually believe about human life, responsibility, and the ethics of inaction… and perhaps the need for substantial more information in this hypothetical. We may also need to ask questions about the assumptions of the question, such as, why do we assume five lives are worth more than one when no measurable value can be placed on a life?

Can we really put a number on a life?

The utilitarian answer is clean and confident: pull the lever. Five lives outweigh one. The arithmetic is straightforward. But this assumes something that many of us instinctively resist — that human lives can be compared, ranked, or traded against one another like items on a balance sheet.

Philosophers call this the problem of incommensurability: the idea that some values simply cannot be reduced to a common scale. Five dollars is worth more than one dollar. But is five lives worth more than one life? The moment we accept that framing, we have already conceded something profound — that people are, in some sense, fungible. Interchangeable. Countable.

Most of us feel, in our bones, that this is wrong. And yet we struggle to articulate why.

“The moment we start counting lives,
we have already made a philosophical choice —
one with consequences far beyond any trolley.”

Context is not a distraction — it is the point

Consider what changes when we add detail to the dilemma. The five adults are elderly, estranged from family, and living rough. The one person is a child with parents who adore them, siblings, a whole life ahead. Does this change the calculus? Should it?

Many philosophers would say we are introducing emotional noise — that the exercise demands we strip away context to test our principles in their purest form. But there is a compelling counter-argument: stripping away context does not purify the dilemma. It destroys it. Because in the real world, a human life does not exist in isolation. It exists within a web of relationships, responsibilities, histories, and futures. The loss of one child reverberates through a family — through parents, siblings, grandparents, friends — in ways that may echo for generations. The loss of five people who have drifted from the world still has weight, still has meaning, but the ripples spread differently.

This is not sentimentality. It is, arguably, a more honest and sophisticated form of moral reasoning than the cold arithmetic of classical utilitarianism.

The Epistemic Objection is a well-recognized challenge. If consequentialism tells you to produce the best outcomes, but outcomes are radically unknowable, then the theory may be practically action-guiding in name only. You can never actually know you’re doing the right thing, which some philosophers argue renders it useless as a decision procedure even if it’s correct as a moral theory.

This connects to what philosophers call the “cluelessness problem”, articulated rigorously by philosopher William MacAskill and others. The argument runs roughly:

• Consequentialism requires you to consider all consequences
• Long-run consequences of any action are deeply uncertain and potentially vast
• Therefore we are systematically clueless about what consequentialism actually requires of us
• This is not a minor inconvenience — it may be a fundamental flaw

The Responses Consequentialists Make

To be fair, consequentialists have replies:

• Expected value theory — you act on probabilities, not certainties. You use the best available estimate of outcomes
• Rule consequentialism — instead of calculating act by act, you follow rules that generally produce good outcomes, sidestepping some epistemic chaos
• Satisficing (good enough) consequentialism — you don’t need to maximise, just produce outcomes good enough

Is doing nothing really doing nothing?

Here is where the thought experiment takes its sharpest turn. Many people, when confronted with the trolley problem, feel that not pulling the lever is somehow morally safer — that inaction absolves them of responsibility. After all, they did not cause the trolley to exist. They did not tie anyone to the tracks.

But this reasoning deserves serious scrutiny. If you are standing at the lever, you have agency. You have full knowledge of the situation. You have the physical ability to intervene. At the moment you choose not to act, you are not opting out of the moral situation — you are making a deliberate choice within it. The mental process is identical to pulling the lever: you weigh your options and select one. The only difference is whether your hand moves.

The philosopher Peter Singer pushed this point hard with a simpler scenario: if you walked past a child drowning in a shallow pond and chose not to help because you didn’t want to ruin your clothes, almost everyone would consider you morally culpable. The water caused the drowning. But your character is revealed by what you were willing — and unwilling — to do.

“Inaction, when chosen consciously by someone with agency and the ability to intervene, is not a neutral act. It is a moral choice — and it tells us something real about who we are.”

This connects to the concept of moral cowardice: avoiding a difficult choice not because inaction is right, but because acting feels uncomfortable, costly, or risky. Virtue ethics — the tradition stretching back to Aristotle — holds that our character is defined not just by what we do, but by what we are willing to do, and what we are prepared to let happen when we could have stopped it.

Where we draw the line — and why it matters

There is another dimension to this worth sitting with: how we decide which living things deserve moral consideration in the first place. If we accept that all life has inherent value, where does that obligation end? Plants are alive. So are insects. So are fish, pigs, chimpanzees.

One principled place to draw the line is at sentience — the capacity to suffer, to experience fear, to feel pain. A heart, a brain, a nervous system suggest an inner life that a plant, however alive, does not possess. This is not a perfect boundary. But it is a reasoned one. And it connects back to the trolley problem in a meaningful way: if what matters morally is the capacity for suffering and the existence of relational bonds, then the texture of each life on those tracks — not just the number — is morally relevant information.

What the trolley problem is really asking

The Trolley Problem endures not because it has a correct answer, but because it refuses to let us hide. It exposes the gap between what we say we believe and what we are actually prepared to do. It forces us to confront whether our moral intuitions are consistent, and whether the frameworks we use — utilitarian calculation, duty-based ethics, virtue and character — can survive contact with a real dilemma.

The most honest response is not to solve the problem, but to feel its full weight. To resist the urge to reduce it to arithmetic. To acknowledge that human lives are not units of currency, that context is not a distraction, and that the decision to do nothing is itself a decision — one that reflects, for better or worse, something true about the person standing at the lever.

There’s always a “trolley” coming.

The trolley problem doesn’t tell us what to do; it tells you something about who you are and forces genuine reflection. That’s closer to virtue ethics territory, ironically — where the question shifts from what produces the best outcome to what does this choice reveal about, and do to, my character.