Death Spiral

Renfro's death saddened those who knew him, but did not surprise them. Many in Hollywood had tried to help him, but his addiction torpedoed relationships and his career. There were small obits, much smaller than his last high-profile appearance in the press, a photograph of Renfro in handcuffs on the front of The Times, arrested during a 2005 raid of skid row for trying to buy heroin.

In contrast, Ledger's passing provoked an outpouring of public grief about talent cut short before its full blossoming. The fiercely talented Ledger certainly did not seem like a man in self-destruction's grip. Yet after his death, tabloids ran stories of the Oscar nominee's supposed double life. Unnamed sources talked about his use of cocaine, heroin and other drugs, which were said to have contributed to the dissolution of his relationship with girlfriend Michelle Williams and subsequent despair.

Still, unlike Renfro, Ledger had spent the last year of his life working frantically, hurling himself into a multi-continent shoot as the crazed Joker in "The Dark Knight," and then plunging into Terry Gilliam's "The Imaginarium of Doctor Parnassus."

All through January, Ledger worked despite having a bad cold that turned into pneumonia. He told the New York Times in November, "Last week, I probably slept an average of two hours a night. I couldn't stop thinking. My body was exhausted and my mind was still going."

In his professional drive, Ledger was different from the members of young Hollywood who usually end up in the tabloids and the police blotters. Paparazzi have been bolstering their bottom lines with an endless array of women in distress -- pretty twentysomethings such as Lindsay Lohan and Spears. Who knows whether women are actually suffering more than men? It's just that the tabloid-fashion-restaurant industries depend on pretty girls to sell magazines, clothes and trendy clubs.

"Drug abuse is so much more underreported than anyone realizes," says one former studio chief, who declined to be named, adding, "I think they [actors] all take a lot of drugs."

Just in recent days, which included Spears' midnight motorcade to the hospital, starlet Eva Mendes checked into rehab. The hit list of young actors with onetime substance abuse problems includes Balthazar Getty, Ben Affleck and Juliette Lewis.