By Rachel Abramowitz, Los Angeles Times  

Actor Brad Renfro's sad death, despite efforts to lift him from substance abuse, was saddening but not surprising in a town that calls to the troubled as well as the talented. 

Brad Renfro had insisted over the phone that he was clean. That's what the teen actor, hot from his performances as a troubled youth with sad eyes in such films as "The Client" and "Sleepers," told director Larry Clark. Clark, one of America's foremost chroniclers of teenage desperation, had just cast Renfro as the lead in "Bully," his true-life tale of a bunch of pot-smoking Florida teenagers who murder the local bully. 

But then Clark met his 18-year-old star.  The director, who'd once battled heroin addiction himself, stopped by Renfro's Knoxville, Tenn., home on the way to the film's Florida location.

It was the summer of 2000, and Renfro emerged from the house that he shared with his grandmother with blood streaming down his arms. He was bloated and looked 35. And so continued a painful, downward spiral -- one of the most excruciating Hollywood has seen of late. 

"I said, 'What the [hell] are you doing?' " recalls Clark. "He'd been banging coke. He has tracks running down both arms. He looks horrible. I just saw the whole movie going down the drain." (Financing was contingent on Renfro's participation.)  Clark spent the next three days with Renfro. They talked. The young actor cried a lot, and continued to shoot up cocaine.

Clark hatched a plan to get him clean for production.  "I kidnapped him," says the director. The pair jumped in the car one day, on the director's pretense of going somewhere, and Clark just "gunned it" for Florida. "He kicked in the car. He had a seizure. There's nothing you can do. It doesn't last that long."

In Florida, the production hired a trainer and a minder for Renfro. Clark took Renfro to 12-step meetings. Still, in the evenings, Renfro would manage to finagle alcohol.  Clark adds, "I've been around a lot of addicts and alcoholics, and I remember thinking at the time, this is one of the worst cases I've ever seen." 

Brad Renfro died Jan. 15, 2008. He was 25.  A week later, 28-year-old Heath Ledger was found dead in his New York apartment. He died of a lethal cocktail of prescription drugs -- among them medications that go by the brand names OxyContin, Vicodin, Valium, Xanax, Restoril and Unisom. 

Saddening, not surprising 

THE cycle of destructiveness seems to have accelerated. It was shocking in 1993 when River Phoenix overdosed from heroin and cocaine at age 23, shocking because of his youth. Now we live in a time when the Associated Press is pre-writing Britney Spears' obituary.

Has Hollywood become an incubator of abuse or a mirror of society? Or are we all just more aware of its troubled denizens because of the hyper 24/7 coverage? 

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, [Heath] 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. 

"I just think what we see in young Hollywood is reflective in what we see happening in young America -- the pandemic of drug addiction," says Dr. Drew Pinsky, who appears in VH1's "Celebrity Rehab With Dr. Drew." "Where we're losing ground is pharmaceuticals drug addiction." 

According to a 2006 survey by the U.S. Department of Health and Human Services, while illegal drug use remains steady, pharmaceutical drug abuse is going up among young adults.

Pinsky reels off some popular culprits: Valium, Ambien, Vicodin, OxyContin, Ritalin.  According to the Centers for Disease Control and Prevention, overdoses kill more people than guns, second only after car accidents. In the most recent data, accidental poisoning deaths (primarily from prescription drugs) rose 62.5% from 1999 to 2004.

Indeed, the New York medical examiner declared Ledger's death an accident, caused by the "abuse of prescription medications." 

Pinsky sees a higher incidence of drug use among celebrities because Hollywood is a magnet for the troubled: "People who come from traumatic backgrounds gravitate toward the solution of becoming a celebrity." 

And the environment doesn't help. "A lot of people who get into trouble with drugs are also people who feel emptiness in their day-to-day lives. They seek drama," says Southern California psychotherapist and addiction specialist Jim Conway.

"For actors who do features, they have this huge circus environment for a few weeks. Then it's over and they're empty." 

It's notoriously hard to control an addicted celebrity and sometimes the only reliable checks seem to be the insurance companies and the police. The insurance companies can refuse to insure substance abusers. A representative for Fireman's Fund Insurance, which covers most studio films, says about 10% of productions have actors with these issues. 

Once an actor has a brush with the law, it can become much harder to get insured. In the recently published "Conversations With Woody Allen," the director bemoans how he'd wanted to cast Robert Downey Jr. and Winona Ryder in "Melinda and Melinda" but couldn't get them covered.

Downey had spent a stint in jail on drug charges; when authorities busted Ryder for shoplifting in 2001, they found eight different painkillers in her purse.

"We were heartbroken because I had worked with Winona before and thought she was perfect for this." 

Yet one lawyer who deals frequently with insurance issues points out that all kinds of deals can be made for a superstar, like daily drug testing or furnishing a sober companion, but "as someone's star begins to fall, there's a lot less will to justify the hoops." 

A key break  BRAD RENFRO'S whole career started, improbably enough, because as an 11-year-old fifth-grader he'd been difficult in a Drug Abuse Resistance Education class taught by a retired policeman.

"He was absolutely your problem child," says Dennis Bowman. "The very first day, I kicked him out of class."

Bowman grew to like Renfro, but "he was still a piece of work as far as being out of control."  By many accounts, he came from a troubled background. His dad, a factory worker, and his mom split up when he was a toddler, and his mom deposited him on the Knoxville inner-city steps of his paternal grandmother.

Says Bowman, "The grandmother was trying her best to raise a kid who was taking advantage of the situation and creating a lot of stress on her."