How many American first ladies created legacies that overshadow those of their presidential husbands? It’s a case that can be argued for Betty Ford, who courageously took on taboo topics such as breast cancer, abortion and addiction—and in doing so, started national conversations that impacted, and saved, countless American lives.

On August 9, 1974, Betty Bloomer Ford was thrust onto the world stage when her husband, Vice President Gerald R. Ford, suddenly became President of the United States. Betty, a native of Grand Rapids, Michigan who had endured her father’s suicide and a brief, difficult first marriage, would recall the day her husband took the oath of office as the saddest of her life. The sadness came from the tremendous empathy she felt for her longtime friend Pat Nixon, whose husband had resigned the presidency in disgrace, but also, there was a sense of overwhelming responsibility. As first lady—a position for which there is no job description or guidebook—Betty’s every word and every move would be in the spotlight. At 56 years old, the former Martha Graham dancer and mother of four wasn’t about to reinvent herself.

“Okay, I’ll move to the White House,” she said, “do the best I can, and if they don’t like it, they can kick me out, but they can’t make me somebody I’m not.”

Seven weeks into her new role, Betty Ford faced an even greater challenge: A routine doctor’s visit had uncovered a lump in her breast.

In 1974, Breast Cancer Awareness Month didn’t yet exist. There were no guidelines for regular screenings, no fundraising walks, no patient-support groups. At that time, the words breast and cancer were spoken in hushed tones—like something shameful. But Betty was adamant she should be completely open with the American people. How many other women in America must be going through this too? she wondered.

Just two days after Betty’s doctor discovered the lump, the first lady went into surgery not knowing whether she had cancer, not knowing whether she would come out of the operating room with one breast or two. In what was standard practice at the time, Betty was put under general anesthesia while the doctors took a sample of the suspicious tissue. The biopsy proved malignant and the doctors immediately performed a radical mastectomy. Within hours of the operation, the White House held a press conference sharing the details of her surgery—including the good news that, largely because the cancer had been detected early, the first lady’s prognosis was excellent.

What happened next was remarkable. Women across the country lined up outside clinics to get breast exams; newspaper articles described how to perform self-exams; and in the first week after Betty’s surgery alone, the White House received more than 35,000 cards and letters.

Many women offered the first lady advice and encouragement from their own experiences, while thousands wrote that her courage to speak out prompted them to get checked. Some wrote with admiration: “One thing you have demonstrated to the American people is that you are not superhuman. You’re just a super lady.” Others expressed how their sentiments crossed party lines: “This has nothing at all to do with my political beliefs, since I would never in my entire life dream of voting for a Republican, but I will pray for you every night and please get better!” Literally overnight, Betty Ford removed the stigma from breast cancer, and changed women’s healthcare forever.

The response to her openness about breast cancer made Betty realize the power of her platform as first lady. One issue she felt strongly about was the Equal Rights Amendment—the proposed amendment to the Constitution that would provide for the legal equality of the sexes and prohibit discrimination on the basis of gender. Betty was a staunch supporter of ERA, but it was a political hot potato—one which her husband’s advisers preferred she avoid.

Not that Betty heeded their advice. In a speech at the 1975 International Women’s Year Conference in Cleveland, she proclaimed, “I do not believe that being first lady should prevent me from expressing my views… Why should my husband’s job, or yours, prevent us from being ourselves? Being ladylike does not require silence.”

While the ERA ultimately fell short of the 38 states required to approve its ratification, Betty continued to speak out on behalf of women’s rights.

Her candor sparked even greater controversy in a “60 Minutes” interview in August 1975, during which reporter Morley Safer probed her about hot-button issues of the time. When asked about the Supreme Court’s recent ruling legalizing abortion, she said “it was the best thing in the world,” because in her opinion it was time to “bring it out of the backwoods and into the hospitals where it belonged.” On the issue of marijuana’s growing prevalence among U.S. teens, Betty said she was sure her own children had probably tried it and that if it had been around when she was a teenager, she probably would have too. When Safer asked how she felt about premarital sex—and more pointedly, how she’d react if her 17-year-old daughter Susan was having an “affair”—Betty said she wouldn’t be surprised because Susan was “a perfectly normal human being” and perhaps premarital relations with the right person might lead to a lower divorce rate.

The response? Nothing short of shock and awe. No first lady had ever appeared on television like this before. While many found her answers appalling, polls showed the majority of Americans viewed her frankness as refreshing. Once again, she sparked a national dialogue—and her popularity soared.

In an interview for BETTY FORD: First Lady, Women’s Advocate, Survivor, Trailblazer, Betty’s eldest son Mike Ford told this author, “There was always a part of her that wanted to break out and come out of my dad’s shadow.” As first lady, Betty Ford was finally able to do just that. In her 1978 memoir, The Times of My Life, she reflected that “in the beginning, it was like going to a party you’re terrified of and finding out to your amazement that you’re having a good time. You never know what you can do until you have to do it.”

When Jimmy Carter beat President Ford in the 1976 presidential election, Betty’s time in the White House—and the spotlight—suddenly ended. The Fords moved to Rancho Mirage, California, a tony community near Palm Springs where they’d vacationed with friends for years, with hopes of enjoying retirement. For Betty, it was a difficult transition. Her husband, in high demand on the speech circuit, traveled almost constantly. And with all four children grown and living independently, Betty was often alone—and lonely.

For the previous 23 years, Betty had suffered chronic pain due to a pinched nerve in her neck. Over the years, doctors had prescribed ever-increasing strengths of pain medication along with Valium to ease her bouts of depression and anxiety. And at the White House, that continued, with the White House physician, Dr. William Lukash, providing Betty with a myriad of pills to ease whatever ailments she had. Like millions of other Americans, Betty presumed that if the doctor prescribed her something, it was safe. There was no warning that her nightly vodka-and-tonic could be detrimental—even dangerous—when mixed with the medication she was taking.

The combination of loneliness, depression, chronic pain, alcohol and prescription pills sent Betty spiraling downward, to the point where her family barely recognized her. Susan, the youngest of the Ford’s children and only daughter, noticed that her mother, who had always moved with a dancer’s grace, had become clumsy and shuffled her feet when she walked. Frequently, she slurred her speech; and many days, she stayed in her bathrobe. One day, Caroline Coventry, Betty’s personal assistant at the time, discovered a stash of prescription bottles. “The amount of medicine was staggering,” she recalled. Coventry wrote down all the medication—it filled three legal pages—and boldly confronted Betty’s personal physician in Rancho Mirage. His response? He thought he’d lose the former first lady as a patient if he didn’t give her what she asked for.

Everyone around Betty—her husband, her children, her friends—realized something was wrong. They just didn’t know what to do, or how to fix it.

VIDEO: Mrs. President: Betty Ford: Find out why historians say Betty Ford, one of our most popular--and outspoken--first ladies, probably did more for American women than any other first lady in history.

In the spring of 1978, Susan shared her worries about Betty to their gynecologist, himself a recovering alcoholic. He brought in some other professionals and a week before Betty’s 60 birthday, the family came together for an intervention.

It was a relatively new technique at the time—and the mere idea terrified them all—but everyone agreed they had to try it. For Jerry Ford, who just 15 months earlier had been the most powerful man on the planet, often making life-or-death decisions, nothing prepared him for this. One by one, family members told Betty stories of times she had hurt each of them while under the influence of drugs and/or alcohol. It was incredibly painful, but over and over again, they told Betty they loved her too much to lose her.

In 1978, there were few options for in-patient treatment for alcoholism and addiction. But after going through a horrible detox at home, under the supervision of a nurse, Betty was admitted to the Alcohol Rehabilitation Center in the Naval Regional Medical Center in Long Beach, California.

Betty agreed to put out a press release stating that she was being treated for an overmedication problem. But it wasn’t until a few weeks into her treatment that she admitted to herself—and the public—that she was also addicted to alcohol.

Like when she had gone public with her breast cancer, Betty’s courageous admission inspired a tremendous outpouring of sympathy and support. Thousands of letters came from people all over the world who applauded her and related to her plight. Often the letters included the question, “How did you do it?” And “Please help me.”

A year after her own intervention, Betty participated in one for her next-door neighbor and close friend, Leonard Firestone. When Firestone, the retired president of Firestone Tire & Rubber Company, came out of rehab, he convinced Betty they should team up to start a stand-alone in-patient treatment center to help others struggling with addiction.

Betty reluctantly agreed to put her name on the facility, which was housed on the campus of the Eisenhower Medical Center in Rancho Mirage, and in October 1982, the Betty Ford Center opened its doors to the first four patients: two men and two women. Betty, who had been integral in every phase of fundraising, design and building, insisted there be an equal number of beds for women as for men. For although women were just as likely as men to be alcoholics, they were far less likely to seek treatment. And when they did reach out for help, most often they were treated through mental-health programs rather than specific treatment for their disease.

Every month for the next 25 years, Betty Ford spoke to the patients at BFC, beginning her talk with, “Hello, I’m Betty, and I’m an alcoholic.” More than 100,000 people have been treated there since the center’s inception, and it remains the only treatment facility in the world that has an equal number of beds for women as for men.

It is impossible to quantify Betty Ford’s legacy or to overstate it. Perhaps the finest tribute came from her husband, the 38 President of the United States: “When the final tally is taken, her contribution will be bigger than mine.”

Lisa McCubbin is the author of BETTY FORD: First Lady, Women’s Advocate, Survivor, Trailblazer and three New York Times bestsellers with Secret Service Agent Clint Hill. Follow her on Twitter @Lisa_McCubbin.

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