Drug abuse in Hollywood is almost as old as the Hollywood hills themselves, but the fondness celebrities have long had for cocaine, prescription painkillers and other dangerous substances goes largely unreported until someone ends up in rehab or dies of an overdose.
Dr. Drew Pinsky, the man behind the VH1 hit show "Celebrity Rehab With Dr. Drew," says the media have a moral responsibility to start reporting on celebrity drug abuse in the wake of the shocking drug-related death of actor Heath Ledger and the drug-addled travails of pop star Britney Spears.
"We have a saying in the addiction field: ' You're as sick as your secrets,"' Pinsky said in an interview from Los Angeles on Thursday.
"Secrets keep addicts ill and cost lives. Families that have addicted members learn to operate with secrecy. And Hollywood is operating, and the media with them, like a sick family. If this secrecy hadn't been maintained, Heath Ledger could be alive today."
Several celebrities, among them Kirsten Dunst, Amy Winehouse and Eva Mendes, have entered rehab in the wake of Ledger's demise, perhaps scared straight about where their proclivities could lead. And there are also signs that Ledger's death has forced news outlets to examine their past tendency to keep quiet about stars struggling with drug problems.
Elaine Lui, a correspondent on CTV's "ETalk," wrote on her blog (www.laineygossip.com) that with Ledger's death and news of Dunst's troubles, perhaps the media and publicists should be more open about drugs in Tinseltown.
"Drugs in Hollywood ... time to stop glossing it over, no?" Lui suggested earlier this week.
In an interview Thursday, Lui said the public would be shocked and scandalized to hear of the many A-list Hollywood stars, most of them household names, who have serious drug habits that go far beyond recreational use.
"You can report on almost anything about a celebrity - you can say she's a bitch, or that he's a racist - but you cannot say they're gay or that they're a drug addict, because that affects their bottom line and their public image and that's when the lawyers start calling," Lui said.
"And it's far easier, from the public's perspective, to hate a journalist or believe a journalist is lying than it is to believe that the actor or actress who they worship is a drug addict. People just don't want to go there. But maybe it's time they should, because I personally feel being a racist is a lot worse than being a drug addict."
Elizabeth Snead, a blogger for the Los Angeles Times, wrote recently about once seeing actor Brad Renfro, who died last month of suspected substance-abuse causes, at an L.A. soiree.
"I watched a very under-the-influence Brad Renfro make quite a scene at a swanky Hollywood party several years ago. Not only did none of his celebrity friends, or the publicists throwing the bash, find his stumbling, slurring, falling down and bleeding nose unusual, but not one reporter covering the party reported it," she wrote.
"I tried to. But it was edited out of my then-newspaper's party item."
Snead added that publicists are often among an addict's worst enablers, concocting stories for the media aimed at shielding what's truly ailing their clients. A case in point is Lindsay Lohan: before the 21-year-old actress's drug problems became well-known, she had been hospitalized for everything from supposed exhaustion, asthma attacks and appendicitis.
Drug use is so prevalent in Hollywood that actress Megan Fox, who starred in the blockbuster film "Transformers" last year, said in a Maxim magazine interview last summer she knows only five other people in Hollywood, other than herself, who do not routinely use drugs.
Pinsky, whose "Celebrity Rehab" begins airing in Canada soon, says Ledger's struggles with substance abuse were an open secret in Hollywood, as are the drug habits of many other stars.
"You should hear all the people talking to me about Heath Ledger, and yet I'm the only person shooting his mouth off out there about what everyone actually already knows," said Pinsky, a medical doctor who specializes in addiction.
"You can't imagine the heat I am taking from his people, who ought to be ashamed of themselves that they not only did that (kept Ledger's drug problems secret) in his life, but are now continuing the same posture after his death - it's crazy."
Pinsky said Hollywood drug abuse is widespread - much higher, in fact, than it is in the general population, because those attracted to acting and fame tend to be narcissists who often struggle with various mental health issues, and then have the means to procure a constant drug supply and keep it quiet when they lose control.
"They have all kinds of pathology," he said, citing a study he did on narcissism among Hollywood celebrities. "It's so obvious that this is a population that has a huge appetite for drugs. So their behaviour, their horrible relationships, their addiction is not caused by celebrity, but is allowed to spiral into a fatal illness because of their celebrity status."