Who's Addicted to Addiction? Sally Satel on the Social Media Trials & America's Therapeutic Culture

00:00:31 Andrew Keen: Hello, everyone. Back in March, there was the so called landmark social media addiction trial in which Meta and YouTube were defeated in court. A lot of people celebrated this. They thought it was a good thing. Big Tech had it coming, and, regular viewers and listeners to the show know that I'm not necessarily one of Big Tech's greatest friends. But the aftermath of this was a little odd. It was, treated as if, it was a massive victory. There were cries and jubilation outside the courtroom, and I wonder whether a lot of it was justified. It's worth me adding the caveat that my wife is head of litigation at Google, so maybe I'm a little biased here. But my guest today, Sally Satel, senior fellow at the American Enterprise Institute, is less biased or at least less has institutional interest in this case, and she has articulated a degree of skepticism. She wrote an interesting piece for Persuasion recently, arguing that social media addiction is way more complicated than you think. And, she has a new book coming out early next year called Not a Disease, which, I'd like to get her back on the show with. Sally is joining us from Washington, DC, where she lives and works. Sally, were you a little disturbed as I was by some of the almost religious jubilation, this euphoria that greeted this addiction trial?

00:02:17 Sally Satel: Well, I'm not surprised. Certainly anytime you have massive litigation, the other side, the winning side is going to be ecstatic. In this case, of course, in a material way, the settlement wasn't settlement to this individual young lady wasn't huge, but it's a so called bellwether case that has implications for future litigation, and what kinds of arguments resonate with juries, and what kinds of strategies. And this, and the subsequent the litigation that's coming down the pike is massive. In fact, just as of yesterday, four states I'm just gonna read this to you very quickly. With four states, California, Colorado, Kentucky, and New Jersey, alleged that the tech giant, this is just Meta, violated their state laws aimed at protecting consumers by misleading the public about the safety of their platforms. And the key point is the $1.4 trillion lawsuit. This is just it's absolutely mind boggling. And as a psychiatrist, what strike strikes me is the concept and reality of addiction, which is what I work with. I'm an addiction psychiatrist and I'm medical director of a methadone clinic, is the way the concept, again, and reality of addiction is being, distorted to, further the aims of the plaintiffs. There may be other reasons to sue and maybe liability in terms of misrepresentation that I'm not misrepresent excuse me. Misrepresentation of potential harms. That's not what I'm interested in, the way they invoke brain science at the most superficial level as you might imagine. The way also they reify addiction as something that is a behavior that is beyond control. And if that were true, my patients would never get better.

00:04:27 Andrew Keen: Yeah. Let's remind ourselves of this case. It involved a woman called, quote, unquote, Kaley, who was awarded $6 million, shared between Meta and, YouTube, Google, although most of it came from Facebook. As you say, not a lot of money. And it was about the idea that she was addicted to social media and essentially ruined her life. Tell me about Kaley and why you're slightly skeptical of the arguments made on her behalf and others in this case.

00:05:01 Sally Satel: Well, there are several. The first is that, she was okay. So her the her allegation successful is that she was harmed by the design features of these platforms. And that the nature of the harm, kind of the mechanism was an addiction, meaning she could not control herself and she was exposed to the point of damage. And, the issue with her and with so many young, kids who are in these situations is that they have fragilities and, vulnerabilities that predate, their exposure to, the platforms. And that in and of themselves could cause the damage that she's alleging, depression, anxiety, suicidal ideation, body dysmorphia. And then you also have an intermediate kind of situation where she was vulnerable to begin with and her interaction with the, medium made things worse. It is interesting, however, that she says her future plans are to be on the be an influencer. So obviously, she also, finds this, you know, social media also a gratifying and productive thing for her. But she did start using when she was very young. Of course, you wonder where the parents were. And her history, was not very healthy. Her parents were highly critical of her. She was very unhappy. Her two but interestingly, her two therapists, testified. And one said that the issue of social media, as an irritant of her life never barely even came up. And the other said that it did come up, but it was very much embedded in a lot of other contextual matters. The way her parents were treating her obsession with her appearance, and how she got involved with, now I forget, it was some beautification app, you know, and very self conscious. So it's this is a very complicated picture and it's not a surprise that, the people who have the most, who are who claim the most damage in these cases are people who walk into these situations already with some difficulties.

00:07:33 Andrew Keen: And, of course, the plaintiff lawyers, are gonna make a lot of money. I know that, Kaley's lawyer flew to the trial, in his own private jet, or at least that's what my wife tells me. Certainly, YouTube was perhaps rather unfairly treated since it's hard to even argue that YouTube is a social media company. But leaving that aside, Sally, let's step back. You're an MD, as you said, as well as a senior fellow at the American Enterprise Institute. What's happening here? On the one hand, we seem to be living a title of one book I know you like. We're living in an age of diagnosis, book by Suzanne O'Sullivan. And on the other hand, we live in an age of anxiety. What comes first, the diagnosis or the anxiety?

00:08:26 Sally Satel: Well, I've been living in an age of anxiety, I for decades. But, well, that's a good question. And I'll just give you a little, vignette here. As I mentioned, I work in a methadone clinic, but obviously the patients have other kinds of psychological problems, as most of us do. And when we do, we take histories on them when they first come in and get their medical history and their psychiatric history. And nine times out of ten when they start talking about their psychiatric history among those who have one, they reel off a series of diagnoses. I have bipolar, I have depression, I have PTSD, and some are even getting the payments based on it. And these are serious. I'm not making light of these conditions. These are very, these can be very life altering and very destructive. But, when I take ask probe more, it turns out that they don't have really any of these. What they call depression, and they have been told is depression. And often what they're medicated for as depression is really a serious case of demoralization. And when you hear about the lives they have, they live in crumbling public housing or they have a partner who's, beats them, I mean, you understand why they would be. PTSD, for example, post traumatic stress disorder. They will say they have post traumatic stress disorder because they told a therapist that they were once shot at or even shot. Now admittedly that's horrifying and one could certainly have post traumatic syndrome from that, but that happened twenty years ago and they don't have it anymore. And on. Bipolar illness is mood swings. Well, if you've ever known anyone with real serious, what's called bipolar I disorder, it is devastating. It's a psychotic condition, and it's or, you know — [unclear] — it's a cycle, then, become, like, immobilized with depression. Sometimes people need shock therapy to emerge from that. Serious stuff, but they don't have it. And they're getting medicated for it. They're told they have this. They use these

00:10:53 Andrew Keen: When you say they're told they have it, are they being told by fellow therapists? Are they being told by social media friends? Are they being told by relatives that they have it?

00:11:06 Sally Satel: No. These particular folks are being told by, other the therapist they have seen often for fifteen minutes, which is inadequate to make a any kind of meaningful diagnosis. But it is true that young kids, younger kids today, are diagnosing effectively by Internet. And, you know, and there's rewards for that. Somehow this is valorized to have a diagnosis. Again, you have a built in excuse for everything. You are, kind of in a victim, you know, category. And people may expect less of you, so you're kind of under less pressure. And in the short run all this stuff is gratifying, but in the long term it just really retards people, especially when you're young. Your development and your engagement with the world, you're fearful, you're expect too much to be given to you and not, you know, not engaging enough with risk and with, challenge. So not good.

00:12:17 Andrew Keen: Not good. Although, you're an MD, and yet you're also involved with all these rather anti therapy books. You co edited a book, one or you co authored a book, One Nation Under Therapy. Another of your books is called Brainwashed: The Seductive Appeal of Mindless Neuroscience. Sally, you don't need me to tell you about the title of your books. Where does all this stop? Are you a skeptic of therapy broadly, or is there still credible therapy somewhere?

00:12:56 Sally Satel: Not at all. Yes. There is. Therapy, can, be enormously helpful. The problem is we have kind of a lot of bad therapists out there. You know, when you think of the mental health workforce, their psychiatrist I'll just put us at the top in terms of numbers, but also to be fair in terms of training. And then, psychologists, these are people who do therapy with, you know, air quotes because there's so many ways people, you know, approach this enterprise. But and then there are social workers, and then there are counselors, and then there are people who calls, you know, life coaches. And the quality, even among my colleagues, I certainly should acknowledge that, is not reliably good. Now that's true of any field, obviously get a bad cardiologist, but psychiatry because it's has there's no procedures in psychiatry. I mean, yes, there's shock therapy, but very few people get it and only psychiatrists can give it. We don't do procedures. We're not gastroenterologists or OBGYN or radiologists. So because we're talking, it's that almost makes it seem like anyone can do it. And that's not quite true. So, I'm very much —

00:14:16 Andrew Keen: And you have to pass exams though, don't you? I mean, to have an MD by your name as you have to pass some quite challenging exams.

00:14:26 Sally Satel: We do, and I think I went to, I have to say, an excellent, training program, and I feel very lucky. I went at a time where, well, the sort of the biological the rev the biological revolution in psychiatry sort of started in the seventies. I was after that, but I got the best of both worlds. I got, kind of got neuroscience and we got Freud and, you know, we have, we had psychodynamic therapy and biological. And you have to, of course, think in terms of both. The brain is obviously the mechanism and the mind is what makes meaning out of situations or out of your ideas about yourself. These have to be integrated. And if you get good training, and I happen to be lucky because I know the people who have, but I also see what my patients get. And sometimes it's not the fault of the psych of the therapist they see. They don't have much time to see the patients, or they're not well trained. But, I would never pick a name out of a phone book. It really it can be a challenge to find someone good. And when they're good, they're great, and no one off.

00:15:39 Andrew Keen: Phone books.

00:15:39 Sally Satel: Pardon me?

00:15:40 Andrew Keen: Yeah. You probably get it on the Internet. And what about over medication, Sally? If everyone is being identified with one kind of mental disease or another or mental condition, Is there also a problem with over medication?

00:15:57 Sally Satel: Oh, yes. Very much so. There is over medication. There are populations where they're certainly under medication. Some minority groups, don't wanna see psychiatrists at all, and, they could probably benefit sometimes from medication. But yes, not only is there over medication because we don't really sometimes there's no time to really talk to people and the reimbursement is better for actually prescribing. Or, you know, you may be benefit from a medication for a few months, but then the you don't need it anymore, but that's not reassessed so you'll stay on it. And, so that's a problem. And excuse me. And people do especially if you're an older person, these medications can interact with other meds you're on or other physical problems, and these aren't paid enough attention to. So, I'm not I may not prescribe methadone for heaven's sakes, and that's probably the best medication there is for opioid addiction. So I'm certainly not against medication in any sense. I and when you have a severe mental illness with psychosis, you almost always need it, and at least while you're in your most, you know, foreign state of delusions or hallucinations. So, no, I'm very I consider myself, or this is the term of my, training program, a trained eclectic psychiatrist, and I consider myself that. It's more a quality that I care about than the nature of, what's administered to people.

00:17:40 Andrew Keen: Brave New World, of course, where everyone was taking so much. We recently had, or last year, David Rieff, very prominent cultural critic on the show.

00:17:47 Sally Satel: Oh.

00:17:49 Andrew Keen: His new book is called Desire and Fate, and he's deeply critical of this broader he's not a medical doctor like yourself, Sally, but he's broadly he's critical of a broader therapeutic culture in which everything is interpreted in therapeutic terms. I'm not sure if you've seen his new book, but would you basically agree with him?

00:18:09 Sally Satel: No. I well, his dad, you know, wrote the famous, why am I — The Triumph of the Therapeutic. I believe that's his dad. David I mean, Philip Rieff. Anyway.

00:18:22 Andrew Keen: Philip Rieff.

00:18:25 Sally Satel: Yeah. I do. But well, Philip, his book was, I believe, more, concern about the therapeutic or substituting for religious kinds of involvement. But and that this has been criticized you know forever the therapeutic culture. Yeah we're in the therapeutic culture. We medicalize, we over medicalize human problems, human disappointment, human sadness. I just again saw a patient today who went in to see a therapist because she was sad about her mother dying, and, I'm not criticizing that. There is good advice to be given on how to deal with grief. But when I asked her what her symptoms were at the time, they were kind of normal grieving behavior. She had she got medication. Did it hurt her? Honestly, I don't I doubt it hurt her, to be honest, but, we definitely have. That's one main pillar of the therapeutic culture now is that we, kind of medicalize normal human, distress.

00:19:42 Andrew Keen: Yeah. I mean that coming back to that idea of normal and brave new world, Huxley, of course, warned us about this a hundred years ago. Are we treating sadness then as being a kind of medical condition? Is that one of the problems?

00:20:01 Sally Satel: Well, I think that, you know, sadness there is no bright line. I can't tell you know, when, you know, dusk, you know, becomes night kind of thing, but, between sadness and depression. But we have, you know, something called the DSM, diagnostic and statistical analysis [sic — Diagnostic and Statistical Manual] now, and it's deficient, gets bigger all the time. That's almost a cultural joke at this point. But I think a lot of people who are on the side of still daylight are misinterpreted through a clinical lens, and that has to do with they've already walked into, you know, a doctor's or a therapist's office. That's kind of a tacit agreement between the two that there's something wrong. And, there may be something wrong. Some people really do, become, just dysfunctional in the face of grief, for example. So, again, I'm not saying that can't happen, but it usually doesn't. And, yeah, it's being it's not being treated in the community or in the, you know, in the religious settings that a lot of people get comfort in and, you know, it's turned into a clinical problem and it's at the very least it's using up resources that should be going to people who have really serious illnesses And those are the folks we don't nearly give enough to.

00:21:30 Andrew Keen: Has this been politicized? You've written some books about, how political correctness is corrupting medicine. You're probably, you're a senior fellow at the American Enterprise Institute, which is maybe a right of center organization. You write for The Free Press, which has a conservative, reputation. To what extent, is this debate now, Sally, for better or worse, a political one between, as you might put it, critics of political correctness or wokeism and people who are in the other camp?

00:22:14 Sally Satel: Well, there's an element there is an element to that. Not to be facile about it, big axes of differentiation is between, you know, what psychologists might call internal versus external locus of control. People who are conservatives, and for the record I'm a raging moderate and a devout atheist, but people who are, tend to be on the right side of the spectrum are more invested in a what's a model of the human that is internally, motivated, directed, and doesn't mean they don't get help from the village, so to speak, but that they're less dependent, especially on the state. And so that is, you know, in itself in some way, anti therapeutic seems too strong a word, but, you know, already is a bias toward being more independent and solving one's problems on one's own if they can. Having a high threshold for, you know, asking for help that is in a clinical context. And, you know, and by contrast, folks on the left, are more I mean, some people will say are more comfortable with emotions. And if you're not into emotion, you're not gonna be very comfortable in therapy. Also, I should say people on the right are probably more likely to get some of their solace and their advice and folks who will listen to them, you know, maybe in the context of the church, they may go to their pastor for these problems. So it's not as if they are being that stoic. They probably do seek out to get some help, but it's in a different, you know, it's in a different institutional setting. So there's that, and of course psychiatry itself, you know, back with Sigmund Freud, the great atheist, I mean, it's, he could, you know, The Future of an Illusion, he considered religious fervor a childhood like a neurosis and so did Jung and so did Carl Rogers, I believe. But anyway, the roots of being impatient with religion go deep. Also my field is, I say my field broadly as the mental health profession not just psychiatry, is more attractive to people on the left. I mean we know that most psychiatrists are would call themselves liberal or left leaning, same with psychologists, so they bring a certain mindset you know as well. And if I can add there's been a very pernicious turn in the therapy field and it's very pronounced in the counseling world, in counselor training where the whole concept of distress is has been changed from being, you know, the idea that the patient is the one who brings their problem to the therapist. They're the ones who define what they wanna work on, what they think is wrong. But in this new, what has been called woke therapy or social justice, critical social justice therapy, the therapist already knows what's wrong. And it's that frankly, if you're a if your patient is a minority, his problems are her problems. And I admit this is almost laughable in its simplicity. It's cartoonish, but it's being taught that the therapist has to conceptualize the problem as being oppressed, that the person is oppressed, they are living in an oppressive society. You know, like a couples therapy, it's a feminist approach where what's wrong is that the woman is the one being somehow abused psychologically, in this relationship. As I say, it's almost laughable, but I can give you one just one example, of how therapists have really, I think, losing their boundary, between what their own personal moral commitments are and they should have them as individuals for sure as private people, but they're letting that bleed into the therapy room. So, I was talking to a young man who works as a junior — a junior fellow, and he is doing —

00:26:53 Andrew Keen: You do have junior fellows, you see.

00:26:56 Sally Satel: So —

00:26:57 Andrew Keen: I was thinking before we went live about only having senior fellows at AEI, but there are some junior fellows.

00:27:04 Sally Satel: And, he saw this therapist who was a psychologist for a few years, no, maybe two. And he's young. He's in his early thirties. And after Trump had gotten elected, his rabbi was going on and on about how afraid he is for transgender youth and that this administration is going to be, you know, hostile to them. And I understand where he's coming from, and I can understand how he could certainly feel that way. But this, young man thought it was just and frankly, he even agreed with him. This young man is no fan of Trump. But he just thought that was, too politicized to bring up in a, kind of religious setting or in the, you know, in a sermon. So he mentioned that to his therapist. I don't know how it fit into the conversation, but I think it was kind of a throwaway point. And the therapist got enraged and, scolded him for not being sympathetic enough to transgender and, basically fired him, you know, told him in the next session she did apologize for getting emotional and then she said she didn't think they could work together. And that is, you know, almost unheard of. You don't fire a patient, you don't let your emotions, you know, poison the relationship that way, but, it's, not and especially in the context of after September, excuse me, October 7, there has been, you know, enormous concern about antisemitism among therapists to the point where now there's a congressional investigation of the American Psychological Association because of alleging and with some good evidence that it's actually been very, you know, receptive to its members, expressing these sentiments. A lot of hostility among fellow psychiatrists. And also, again, disconnect the one I just described coming up in therapies.

00:29:21 Andrew Keen: So in other words, whatever your politics are, you can shape it, dress it up for a therapeutic culture. Let's get back to social media. You wrote an interesting piece in The Free Press about whether we can really be addicted to social media. Can we, Sally, from your point of view, wearing your MD cap?

00:29:41 Sally Satel: Right. Well, that's the key point, and this is actually what was in the Persuasion article, is that if you're a clinician, what's addiction? I mean, fundamental yes, this is the this is where I made the argument I'm about to tell you. What is addiction? Yes. There are 11 criteria for it in this DSM-5, a document that I mentioned, the diagnostic and statistical manual. But basically, they come down to the following. One is that you engage in something too much. Heroin, cocaine, alcohol, smoking, social media, although that is not recognized by the American Psychiatric Association as an addiction. But gambling is, so these behavioral addictions, you do too much of it, you can't you believe you can't stop or have a lot of great difficulty

00:30:37 Andrew Keen: with people. Eating and sex, everything could be an addiction. Right?

00:30:41 Sally Satel: Yeah. And, thirdly, you are harmed by this behavior that you, the success of behavior that you can't control, that you feel a craving for an intense craving for. And there that's addiction. So if that's how we define addiction then I think some people who [unclear] probably have something we could recognize. And if they walked into, you know, a clinic of, people who were trained in, addiction or behavioral addictions, even substance addictions, they'd know what to do because there is a kind of a common theme typically to this behavior. Some of it is behavioral. I mean, try to help the patient identify what kinds of cues, elicit, this is very Skinnerian, sort of elicit the craving and the desire to engage in this, in the drugs or the behavior. And so for example, and some of these cues are very idiosyncratic. I had a patient who was involved with cocaine and he was a teacher And he found, it very hard to be around chalk chalkboards because, I don't know if they use now we use whiteboards and markers, but, some places still use these chalkboards and the chalk dust looks can look like cocaine. And he would immediately start craving. Another woman who, had track marks on her arm, and she had to wear long sleeves, obviously for cosmetic reasons, but also because she just looked at her arms and she wanted to use. So these are idiosyncratic, cues, but some of them are very obvious cues. For example, hanging around with your friends you used to get high with, or going to a bar if you're, you know, have an alcohol problem. And it's the classic people, places, and things. Sounds like a cliche, but it's not. That you really have to identify, you know, problem triggers for you. And that's very, behavioral. It's good to have a person walk through these things with you, teach you how to observe yourself. So that's all very important. How to essentially put barriers between you and these, cues. Don't drive by your dealer's house. Make sure you have direct deposit. Every time you have money, I know you're gonna spend it on drugs.

00:33:23 Andrew Keen: Well, that's all very well with that. But when it comes to social media, if you are indeed addicted

00:33:27 Sally Satel: [unclear] So —

00:33:30 Andrew Keen: Are you suggesting that anytime someone gets their phone out, that they're somehow liable to fall back into their addiction?

00:33:39 Sally Satel: No. But they could if they have a if they have probably could. That's why they have shut off the phone a certain time or turn it to grayscale or, you know, turn off the audio bits so they don't hear the little pinging. You know, obviously, hopefully their parents would confiscate it at certain times. So those are behavioral kinds of self binding strategies. And that's the first layer, and that's really how you break control. If your problem happens to be heroin, thank goodness you can if you want to, not everyone needs methadone, but you can be on methadone, you can be on another drug that's also a replacement opioid called buprenorphine, or Suboxone. And that will help suppress the craving, you know, as well. But we don't have that for I mean, GLP-1s may have a role in that at some, you know, as we're studying. But in any case, there's the behavioral dimension, and then there's the more psychological dimension, which is why do you need these things? It's not just driven by your brain and dopamine. I've only put air quotes around dopamine because it's a very real and powerful neurotransmitter, but it's not the only one involved in addiction. So in those strategies both, you know, how to walk through the behavioral and walk through the steps of, trying to insulate yourself from the use and then working more working on, well, what are the psychological drivers of this? Why is it so important to you? And that's harder. And, sometimes that can't be engaged in until the person is, you know, well into a phase now where they're not using at all. Because every time, you know, row of emotions, you can get responses that make the person anxious. And their reflexive go to strategy for anxiety is to use drugs or to go back to their, you know, social media. So —

00:35:43 Andrew Keen: But is there —

00:35:44 Sally Satel: [unclear]

00:35:48 Andrew Keen: But speaking of reflective response to all this, given that we increasingly, in America at least, live in an age of tech skepticism, big tech is public enemy increasingly number one, Should we beware of some of these addiction cases, whether it's the one from March where, Meta and YouTube were found guilty or increasingly concerned about the, addictive quality of AI. There's all these reports about teens now becoming concerned about their attachment to chatbots. What should we do, Sally, about, technology and addiction? What's your advice?

00:36:39 Sally Satel: Well, let's see. Well, some of these there's actually a lot of good websites about the, kinds of interventions that I was alluding to before. Just simple strategies. But, these, you know, social media bans are. I'm not sure that I'm I mean, I don't think social media cell phones shouldn't be in classrooms. That's for sure. Whether they should be banned at how rigidly I'm not quite sure. So I mean I, and if you're a parent for heaven's sakes, I mean that's really you've gotta pay attention to this kind of thing. And your whole social group, see this is always a hard thing because it's the so called collective action problem where your kid, you know, maybe you're the parent who's really conscientious and unwilling to bite the bullet and be the bad guy, but, you know, someone's your next door neighbor isn't. All the parents, all the teachers, everyone has to agree. And I know that's happening some places, and Jonathan Haidt, of course, has documented brilliantly. But, Andrew, if we could go back for just a second to, when you asked me, does social media addiction exist? And I said yes, but that was in a clinical kind of a clinical sphere. I do think that the I do think that in a legal sphere where causation is so important, that social media addiction is kind of an incoherent concept. And I'm not referring here to all those other factors that let's say, Kaley had in her life that may have caused her to be depressed and, you know, other explanations for —

00:38:21 Andrew Keen: One of the — Kaley of the trial earlier this year.

00:38:27 Sally Satel: Yeah. I'm referring to the part of the argument. You know, the trial lawyers, they're addicted to all this, and that's why they were harmed. It's well, okay. So you're saying they have no control at all. And because that's really the essence of addiction, that's why it's so rhetorically powerful. That's why people it wouldn't even when they're kidding, they say I'm addicted to, you know, whatever, fill in the blank. But are you re do you really have no control? And in the case of, you know, a lawsuit where lots of money is at stake, and believe me I have no conflict of interest, I don't know Mark Zuckerberg, I have no fondness for, you know, this is not interacted with at all. But if you're going to say that a product, may that a product was so powerful that it put you in a state where you could not control yourself, you should prove that. You should you better be prepared to prove that you couldn't control yourself. And here's the trick, though. It's a little bit of a trick, proposition because you can't you cannot prove it. There's no way to prove that self control was not possible. In other words, push, you can do as many brain scans as you want, but you're not never be able to distinguish an impulse that wasn't resisted from one that's irresistible. We don't have the technology for that. And so it's unproved that part is unprovable. And I'm not a lawyer. I don't know how this would fit into a trial, but, instead of fighting over whether social media [addiction] exists, my view is it's just not a meaningful concept in a legal venue because you can't prove the thing that is supposedly the mechanism of harm.

00:40:23 Andrew Keen: You're coming out with a book next year, Not a Disease, Rethinking Addiction in the Heart of America's Overdose Crisis. You're on the front lines of that. We'll get you back on the show, Sally, to talk about that in the new year. But you recently wrote an interesting piece for The Free Press about why fentanyl deaths are falling. So maybe we can end on a more positive note, because often these conversations about addiction and technology and kids are very depressing. Where's the good news at the moment when it comes to addiction and drugs and the deaths from drugs like fentanyl?

00:41:03 Sally Satel: Yeah. Well, actually, the good news for the previous discussion, it's there if people are motivated. And sometimes their lives are so old [as spoken]. Frankly, they're not motivated to change because they need they feel they need their drugs as a way to cope. And that's a big challenge. But yes, fentanyl — deaths are going down. That's the good news. I guess I can't help but get some bad news out here is that doesn't mean fewer people are using fentanyl. That's not so dramatic, but it is very important that many fewer are dying. I mean, a significant drop. And that's their, like most things, very few things are monocausal and that's not either, but, some of the, candidate explanations, they're not mutually exclusive. They're all true. One is that Narcan, naloxone, which is the antidote for, overdose, opioid of any kind, overdose is just flooding the market. I mean flooding the streets. In some neighborhoods, they actually nail up boxes of Narcan on telephone poles. They give them out for free at public health clinics. So in other words, if heaven forbid you see somebody who's turning blue on the street and a needle in their arm, you just, you know, some people think everybody should carry a Narcan, I mean I do [unclear], but, it's just a good Samaritan thing to do. And you just it's very user friendly. You just spray it in someone's nose and then call 911. But, it will revive them because it shoves the opioid molecules off the receptor. So it's effective. So that's one reason. Another is that in China, the fentanyl supply is going down somewhat. Also Mexican gangs have been a little disrupted. So we're getting less, somewhat less fentanyl in this on the streets. Then, we've got, you know, the dynamics that occur in pretty much any drug epidemic, which is that the this the upcoming generation is going, well, I don't want any part of this. So, there are fewer new recruits to fentanyl use. This was a dynamic that was very well articulated in the crack epidemic. So many rappers wrote about that, just how awful crack was. So there's that just that generational thing. And then you know the morbid explanation too is that a lot of the folks have died off. And, so not only are they not being replaced, they're dying off. You know, there may be other explanations, but those are the big ones.

00:43:43 Andrew Keen: No. I thought you were gonna cheer us up, Sally. You've sort of half cheered us up, half depressed us, but fentanyl deaths are fortunately falling, although not all of the news about that is good. Meanwhile, social media and AI is becoming more and more therapeutic or treated in a therapeutic way. And I'm I think it's good that we have skeptics like Sally Satel, who is an MD herself, also a senior fellow at the American Enterprise Institute, to make us think a little bit more coherently and responsibly about this. She has a new book coming out, early next year, 2027, Not a Disease, Rethinking Addiction in the Heart of America's Overdose Crisis. Sally, I will get you back on the show with that. Really nice to talk to you. Thank you so much.

00:44:31 Sally Satel: Oh, thank you so much. Appreciate it.