Public figures seek rehab for a host of ills: drug, alcohol and gambling addictions; racism; and even, in the case of evangelical minister Ted Haggard, who had to resign his pulpit after admitting to an affair with a male prostitute, for homosexuality. (Mr. Haggard's aptitude for rehab is positively epic; his therapists declared him "completely heterosexual" after only three weeks of treatment.) Mr. Haggard is not the only public figure to use rehab as a timely escape from scandal. Rep. Mark Foley checked into rehab for alcohol addiction after a congressional page revealed that Mr. Foley had been sending him inappropriate text messages, and Rep. Patrick Kennedy sought treatment for an addiction to painkillers after crashing his car into a security barrier on Capitol Hill.

For celebrities, the journey to rehab frequently follows a formula: Erratic or destructive behavior yields gossip-column space about so-and-so's "cry for help," and within days a publicist is issuing a press release stating that the celebrity in question has "voluntarily checked herself into rehab." Completing rehab is now the secular version of being "born again"--stars emerge "healthy" and eager to discuss their conversion experience with the press, although not all of them appear wiser for it: Hours after leaving rehab, starlet Lindsay Lohan could be found club-hopping around Hollywood. This efficient, well-publicized rehabilitation experience is far removed from the rehab of previous centuries. The treatment facilities of today may have anodyne names such as the Promises Treatment Center in Malibu, Calif., where Ms. Spears is now comfortably ensconced. But addicts in the 19th century endured treatment in places like the Franklin Reformatory Home for Inebriates in Philadelphia. Admittance to these homes marked one as a moral failure and a community danger, not a person suffering from transient impulse control and a poor public image.

By the late 19th and early 20th century, sanitariums and spas had sprung up in cities across the U.S. to treat a host of real and perceived ailments. The Battle Creek Sanitarium in Michigan, for example, run by a quirky physician and Seventh-Day Adventist named John Harvey Kellogg, boasted an impressive list of former patients, including Amelia Earhart, Thomas Edison and Upton Sinclair. Here public figures suffering from undisclosed physical complaints or simply "nervous exhaustion" could spend a month in comfortable privacy taking water cures, playing golf, and avoiding all animal products and stimulants.

The modern rehab movement--democratic, nonjudgmental, and emphasizing addiction as a disease rather than as a character flaw--might be said to have started in 1947, with the founding of the Hazelden treatment center in Minnesota, which was established as "a sanatorium for curable alcoholics of the professional class." From its modest beginnings, Hazelden, which embraces the "12-step philosophy for lifelong recovery," has grown into a small empire, with treatment centers in several states, a publishing house and an impressive online network that will send you daily email meditations and iCare cards. Other residential rehab programs, such as Phoenix House, founded in 1967 in New York by six former heroin addicts, have also expanded considerably.

The late 20th century spawned the celebrity rehab center, with former First Lady Betty Ford opening the Betty Ford Center in 1982; musician Eric Clapton opened his own Crossroads Centre in Antigua in 1993. Today the Betty Ford Center's Web site looks dowdy next to the polished images and poignant strains of violin music that stream from the Web site of Promises, which markets itself more like a sumptuous resort than a rehab facility.

Promises describes its program as "an unparalleled recovery experience" and boasts: "Our Malibu facility offers uncommon luxury and is the rehab facility of choice for business executives, professionals, celebrities, government officials and anyone wanting the finest rehab program in the world." At a cost of more than $30,000 for a typical stay, Promises is unlikely to treat a working-class mother with a methamphetamine addiction. As the head of the Betty Ford Clinic noted recently, the swanky accoutrements of places like Promises, which offer massages and gourmet meals, undermine one of the goals of rehab: to learn some humility. "The best thing for you in rehab is to sit next to a guy from skid row and realize you're just as much an alcoholic as he is," he told a newsmagazine.

But Promises may well be the future of rehab. Just as sashimi and yoga have found their way from trendy enclaves into suburban strip malls, so too might a taste for a well-pampered rehab experience. Thanks to "American Idol" and YouTube, an increasing number of ordinary people consider themselves celebrities--even if their fame is specious or embarrassingly brief. It is not hard to imagine them aping the experience of the truly famous by indulging in bad behavior and then going off for a stint in rehab in a desperate search for authenticity and a "cure." The distinction between self-help and self-promotion could well be lost.

This would be a shame. Rehab may be a fashionable charade in certain quarters today, and an expensive one, too, but the real thing has helped people get clean and stay sober, and the counselors who treat addicts deserve respect for what they do. It would be unfortunate if the whole idea of rehab--the grueling process of overcoming your worst self--lost its legitimacy thanks to the shallow trends of our celebrity-obsessed culture. And what of fair Britney? Although a tabloid legend by 25, she once seemed to have some talent. Let us hope that she will conquer her addictions and return to the perky pop life she was meant to lead. If she does, perhaps in 20 years she can open the Britney Spears Moment of Truth Rehab Center, where patients receive treatment and--who knows?--a commemorative tattoo upon completion of the program.

-- Ms. Rosen is a fellow at the Ethics & Public Policy Center in Washington.