“You can do as many brain scans as you want, but you’ll never be able to distinguish an impulse that wasn’t resisted from one that’s irresistible.” — Sally Satel on why social media addiction can’t be proven in court

When Meta and YouTube lost the so-called landmark social media addiction trial back in March, there was jubilation inside and outside the courtroom. Finally, Big Tech seemed a bit less big. Justice, it seemed, had finally been done.

Or maybe not. (Full disclosure: my wife is head of litigation at Google, so I might be a bit biased). But today’s guest, the psychiatrist Sally Satel, doesn’t have a dog (or husband) in the fight, and she’s a skeptic of the trial’s outcome. A senior fellow at the American Enterprise Institute and the medical director of a Washington methadone clinic, Satel argues that the concept of addiction — her clinical specialty — was distorted in the trial to serve a $1.4 trillion litigation pipeline. The plaintiffs’ theory reifies addiction as behavior beyond control. If that were true, Satel argues, none of her patients would ever get better.

Satel comes at this as a doctor rather than a moralist. Clinically, she acknowledges, social media addiction exists — excessive use, loss of control, continued harm — and the treatments are the same behavioral strategies she uses at her clinic. But legally, where causation is everything, the plaintiff argument collapses. No brain scan can ever distinguish an impulse that wasn’t resisted from one that’s irresistible. The mechanism of harm is unprovable — a ludicrously brittle foundation, Satel argues, for a trillion dollars of lawsuits against social media companies.

So when is “addiction” really addiction? Satel’s upcoming book Not a Disease: Rethinking Addiction in the Heart of America’s Overdose Crisis, which will be out in early 2027, addresses this awkward truth. And we’ll certainly have her back on the show to discuss.

Five Takeaways

•       The $1.4 Trillion Distortion of Addiction. The March bellwether verdict awarded “Kaley” $6 million from Meta and YouTube, but the real story is the litigation pipeline behind it — four states suing Meta in a single day, with total claims reaching $1.4 trillion. Satel’s objection is professional: the lawsuits invoke brain science at the most superficial level and reify addiction as behavior beyond control. If addiction truly extinguished self-control, her methadone patients would never get better — and they do. Kaley herself had fragilities that long predated the platforms, one therapist testified social media barely came up in her sessions, and her stated career plan is to become an influencer.

•       Clinically Real, Legally Incoherent. Satel’s central distinction: in a clinic, social media addiction is a recognizable condition — excessive use, loss of control, continued harm — treatable with the same strategies she uses for drugs, from identifying idiosyncratic cues to self-binding tactics like grayscale screens and switched-off notifications. In a courtroom, where causation is everything, the concept falls apart. No brain scan can distinguish an impulse that wasn’t resisted from one that’s irresistible; the technology simply doesn’t exist. The mechanism of harm at the center of the litigation is not just unproven but unprovable.

•       Demoralization Is Not Depression. At her methadone clinic, nine patients out of ten arrive reciting diagnoses — bipolar, PTSD, depression — that closer examination reveals they don’t have. What’s medicated as depression is often demoralization: the entirely understandable response to crumbling public housing and an abusive partner. Younger people now diagnose themselves by internet, because a diagnosis has become valorized — a built-in excuse, a victim category, less expected of you. Gratifying in the short run, Satel argues, and developmentally retarding in the long run: less engagement with risk, with challenge, with the world.

•       The Therapeutic Culture Meets Woke Therapy. Sixty years after Philip Rieff’s Triumph of the Therapeutic, the medicalization of ordinary sadness is complete — grief becomes a prescription, and resources drain away from the seriously ill. The newer turn is political: counselor training now teaches that the therapist knows what’s wrong before the patient speaks — oppression — and a congressional investigation is examining antisemitism within the American Psychological Association. Satel’s emblematic story: a young man fired by his therapist for gently suggesting his rabbi’s sermon had become too politicized. You don’t fire a patient, she notes. The therapist’s moral commitments bled into the room.

•       The Good News About Fentanyl. Fentanyl deaths are falling significantly — not because fewer people use, but because far fewer die. Narcan is flooding the streets, nailed up in boxes on telephone poles and handed out free at clinics; the Chinese supply has tightened and Mexican distribution has been disrupted; and, as in every drug epidemic, the upcoming generation is opting out — the same dynamic the rappers documented during crack. The morbid factor is real too: many long-term users have died. Satel’s book Not a Disease — rethinking addiction from the front lines of the overdose crisis — arrives in early 2027.

About the Guest

Sally Satel is a psychiatrist, a senior fellow at the American Enterprise Institute, and the medical director of a methadone clinic in Washington, DC. She is the author or co-author of PC, M.D., One Nation Under Therapy, and Brainwashed: The Seductive Appeal of Mindless Neuroscience, and her essays appear in Persuasion and The Free Press. Her new book, Not a Disease: Rethinking Addiction in the Heart of America’s Overdose Crisis (MIT Press), is out in early 2027.

References:

•       Not a Disease: Rethinking Addiction in the Heart of America’s Overdose Crisis by Sally Satel (MIT Press, early 2027) — drawn from her years on the front lines of the overdose crisis.

•       Satel’s recent Persuasion essay arguing that social media addiction is more complicated than the litigation suggests, and her Free Press pieces on social media addiction and on why fentanyl deaths are falling.

•       One Nation Under Therapy and Brainwashed: The Seductive Appeal of Mindless Neuroscience — Satel’s earlier assaults on the therapeutic culture and superficial brain science.

•       The Age of Diagnosis by Suzanne O’Sullivan — the book behind the episode’s framing question: which comes first, the diagnosis or the anxiety?

•       Philip Rieff — whose The Triumph of the Thera...