What’s in a Word?
by Daniel Neff, MD, FAPA
Daniel Neff, M.D. is a board-certified psychiatrist and addiction psychiatrist dedicated to advancing evidence-based treatment for substance use disorders. He completed his undergraduate studies in Biology at Duke University before earning his medical degree from Jefferson Medical College. Dr. Neff then pursued residency training in psychiatry at Thomas Jefferson University Hospital, followed by fellowship training in Addiction Psychiatry at the University of Pennsylvania.
Dr. Neff currently serves as Medical Director of the Mirmont Treatment Center within Main Line Health and as an Addiction Psychiatrist with Mirmont Outpatient Centers. He has previously held multiple leadership roles at Thomas Jefferson University Hospital, including Associate Medical Director of the MATER and My Sister’s Place treatment programs and Associate Clerkship Director for the Department of Psychiatry and Human Behavior.
Committed to medical education, Dr. Neff has held faculty roles at Sidney Kimmel Medical College and currently serves on the volunteer faculty of the Philadelphia College of Osteopathic Medicine. His scholarly work includes peer-reviewed publications, book chapters, and presentations at local and national conferences, particularly in addiction psychiatry, psychopharmacology, and the intersection of medical and psychiatric care.
Dr. Neff is active in professional leadership and committees, including service within the American Psychiatric Association and Philadelphia Psychiatric Society, where he formerly served as Secretary. He has been recognized with several awards for teaching, humanism, and excellence in clinical care.
What’s in a Word?
The astute psychiatrist attends not only to the manifest content of therapy, but also to its latent meanings. Curiosity about what underlies the words a patient chooses is fundamental to our work. Indeed, Freud devoted a substantial portion of his Introductory Lectures to language, and the psychoanalytic exploration of language as a means of understanding both society and ourselves has a rich and enduring history. More recently, medicine has become increasingly attentive to the ways language can unintentionally create stigma. For example, there has been a deliberate shift away from defining individuals by their diagnoses and toward describing them as people who have diagnoses. Much of the language that permeates substance use treatment, however, remains burdened by moral frameworks that predate our current understanding of addiction as a chronic brain disease.
Today, I propose a different lens through which to examine the language we use. Rather than focusing on stigma or historical paradigms, I suggest that our language may reveal some of the latent societal insights on the psychopathology of substance use itself. Further, I suggest that keeping this understanding present in treatment can guide superior outcomes.
Substance (Ab)Use
When considering modern language, it is often useful to return to its roots. Few approaches are as illuminating as examining original Latin meanings of words so rooted, as “substance” and “abuse” both are. I have often argued that Latin, with larger webs of connotations than the more limited ones of English words better represents the inherent structure of thought.
Let us begin with abuse. The word combines utor, a verb meaning “to use,” with ab, a preposition conveying “away from” among its many possible meanings. Together, they communicate the sense of using something other than intended, taking away from its proper purpose, or, in a more traditional sense, using it up.
Now consider substance. This word is formed from sub (“under”) and stare (“to stand”). Together, they evoke the image of that which is beneath us, the ground upon which we stand. For our purposes, we might think of substance as a key organizing principle of the psyche or self.
Language evolves alongside society, reflecting our collective beliefs while simultaneously shaping them. It functions in an ongoing dialogue with the collective unconscious, informing and being informed by it. The etymology of these terms offers a suggestive lens through which to view what society has learned about substance use.
The word abuse does not merely imply the act of consuming a substance. It also mirrors the reality that, in many cases, the substance comes to consume the individual. This raises an important question: Is it the substance that is abused, or the patient?
Likewise, many individuals turn to substances in search of stable ground upon which to stand. Whether driven by trauma, grief, adverse childhood experiences, psychological suffering, or existential uncertainty, substances often provide a temporary sense of solidity, escape, or safety. While that foundation is ultimately unstable, we must not lose sight of the fact that, for a time, it represented the firmest ground the individual could find. When we remove it, we inevitably create disequilibrium. Patients may experience this loss not merely as withdrawal, but as a profound unmooring, the sensation of falling into an abyss.
For this reason, we cannot reasonably expect someone to relinquish their precarious footing without offering something more enduring in its place. Recovery requires the development of a more stable foundation, whether ethical, relational, personal, spiritual, or existential, upon which a person can build a meaningful life.
Finally, it is worth considering these terms together. Substance abuse does not merely affect the substances a person uses; it erodes the very substance of the person themself. By the time many individuals enter recovery, their lives and identities have been so thoroughly consumed that they struggle to remember who they once were, let alone discern who they are in the present or who they wish to become. Recovery, therefore, requires more than the removal of a substance. It demands the reconstruction of a life, the restoration of meaning, and mooring the soul. Only then can treatment move from sobriety to genuine recovery.