Amy Winehouse drank herself to death. That was the ruling of a coroner's inquest into the death of the Grammy-winning soul singer, who died with empty vodka bottles in her room and lethal amounts of alcohol in her blood — more than five times the British drunk driving limit.
Coroner Suzanne Greenaway gave a verdict of "death by misadventure," saying Wednesday the singer suffered accidental alcohol poisoning when she resumed drinking after weeks of abstinence.
"The unintended consequence of such potentially fatal levels (of alcohol) was her sudden and unexpected death," Greenaway said.
The 27-year-old Winehouse had fought a very public battle with drug and alcohol abuse for years, and there had been much speculation that she died from a drug overdose. But a pathologist said the small amount of a drug prescribed to help her cope with the symptoms of alcohol withdrawal had nothing to do with her death.
Instead, a resumption of heavy drinking killed the singer, best-known for her tall beehive hairdos and Grammy-winning album "Back to Black." A security guard found Winehouse dead in bed at her London home on July 23.
"She's made tremendous efforts over the years," said Dr. Christina Romete, who had treated Winehouse. But "she had her own way and was very determined to do everything her way."
Winehouse gave up illicit drugs in 2008, but had swerved between heavy alcohol use and abstinence for a long time, Romete said. The singer had resumed drinking in the days before her death after staying away from alcohol for most of July, she said.
Romete said she warned Winehouse of the dangers of alcoholism. "The advice I had given to Amy over a long period of time was verbal and in written form about all the effects alcohol can have on the system, including respiratory depression and death, heart problems, fertility problems and liver problems," she said.
Winehouse joins a long list of celebrities who died after fighting alcohol problems, including jazz great Billie Holiday, AC/DC lead singer Bon Scott, film legend Richard Burton, writers Dylan Thomas and Jack Kerouac, and country music pioneer Hank Williams.
Witnesses testifying Wednesday said the singer showed no signs she wanted to kill herself and had spoken of her weekend plans as well as her upcoming birthday just hours before she was found dead.
"She was looking forward to the future," Romete said, describing Winehouse as "tipsy" but calm when they met the night before her death. That night, her live-in security guard said he heard her laughing, watching television and listening to music at home.
The guard, Andrew Morris, said he knew she had resumed drinking, but did not notice anything unusual until he found that she had stopped breathing in bed the next afternoon.
Police Detective Inspector Les Newman said three empty vodka bottles — two large and one small — were found in her bedroom.
Pathologist Suhail Baithun said blood and urine samples indicated Winehouse had consumed a "very large quantity of alcohol" prior to her death. The level of alcohol in her blood was 416 milligrams per 100 milliliters, he said — a blood alcohol level of 0.4 percent. The British and U.S. legal drunk-driving limit is 0.08 percent.
The singer's parents attended the hearing, but did not speak to reporters. In a statement, Winehouse family spokesman Chris Goodman said it was a relief to the family "to finally find out what happened to Amy."
"The court heard that Amy was battling hard to conquer her problems with alcohol and it is a source of great pain to us that she could not win in time," he said.
Doctors say acute alcohol poisoning is usually the result of binge drinking — the human body can only process about one unit of alcohol, or about half a glass of wine, an hour. Having too much alcohol in the body can cause severe dehydration, hypothermia, seizures, breathing problems and a heart attack, among other difficulties.
There is no minimum dose for acute alcohol poisoning and the condition varies depending on a person's age, sex, weight, how fast the alcohol is drunk and other factors such as drug use.
In recent years, the 5-foot-3-inch Winehouse had appeared extremely thin and fragile.
Dr. Joseph Feldman, chief of emergency services at Hackensack University Medical Center in New Jersey said Winehouse likely developed a tolerance for large quantities of alcohol after drinking heavily for years. He also said the sedative Winehouse was on, Librium, wouldn't have stopped someone from having seizures if they were in alcohol withdrawal.
"It's easier to withdraw from heroin than it is from alcohol ... Withdrawal (from alcohol) can cause anxiety, tremors, hallucinations, the sensation of things crawling all over you," he said.
He said those symptoms sometimes push people back to alcohol.
"It's possible she could have been saved if she had been found (or treated) earlier," he said. "A lot of treatment is supportive care, like IV fluids and making sure they don't inhale their own vomit."
Winehouse's breakthrough "Back to Black" album, released in 2006, was recently certified as the best-selling disc in Britain so far during the 21st century. The updated take on old-time soul also earned five Grammy Awards.
Although the singer was adored by fans worldwide for her unique voice and style, praise for her singing was often eclipsed by lurid headlines about her destructive relationships and erratic behavior. Winehouse herself turned to her tumultuous life and personal demons for music material, resulting in such songs as "Rehab."
In June, Winehouse abruptly canceled her European comeback tour after she swayed and slurred her way through barely recognizable songs in her first show in the Serbian capital, Belgrade. She was booed and jeered off stage and had to return to Britain to recover.
Her last public appearance came three days before her death, when she briefly joined her goddaughter, singer Dionne Bromfield, on stage at The Roundhouse in Camden, near her home.
Associated Press Medical Writer Maria Cheng contributed to this report.