Can Court-ordered Rehab Work?

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Lindsay Lohan checked in at the Betty Ford Clinic this week, marking at least the seventh time she’s been in rehab. Lohan’s case isn’t even all that unusual, as the New York Daily News points out with a slideshow featuring over 40 celebrities who have been in rehab. Meanwhile, Gawker published a guide to the most popular rehab centers among celebrities.

But it raises the question: Does court-ordered rehab work?

It can, said Dr. Marvin Seppala, chief medical officer at Hazelden, a preeminent treatment center for alcohol and other drug addiction. In fact, knowing that over 90 percent of its patients are “forced” to be there, either by a court or employer or family, Hazelden researched this question internally a few years ago. The results were surprising.

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“The assumption is that those who come on their own are more likely (to succeed), but no, it's the same, or even a slightly better outcome” for those coerced into checking in, Seppala said. “It may be that it's gotten to the worst point for those people, so there’s more motivation to address the issue. But people don't have to believe it's going to work, or even to recognize they have a problem, at the onset.”

Still, statistics show just how challenging recovering from addiction can be: The best rehab programs find that about 55 percent of their patients are clean at the 1-year mark, Seppala said. That might seem low, but Seppala points out that it compares favorably to other chronic illnesses (hypertension or diabetes, for example) that require major lifestyle changes. And he expects the statistics to improve as understanding of the brain improves.



"The brain is affected by the problem, and it's the very organ that's supposed to help you," Seppala said.

There are long-term brain changes -- taking weeks or months to heal -- that occur in addicts that scientists are just beginning to understand, he said. At a very basic level, the reward center of the brain gets reprioritized, so that addiction supersedes normal survival behavior. And it's subconscious, so the patient doesn't recognize life-threatening situations.

Combine that with the complications of leading a celebrity lifestyle, and the penchant to focus on a celebrity's failures, and Lohan's situation becomes more understandable. Lohan’s own feelings on her current rehab stint seem fairly ambivalent.