Betty Ford, pioneer of rehab and former First Lady, dies at 93

Family spokeswoman Barbara Lewandrowski said the former first lady died at the Eisenhower Medical Centre in Rancho Mirage. Her husband, Gerald Ford, died in December 2006.

"She was a wonderful wife and mother; a great friend; and a courageous first lady," former president George Bush Snr said in a statement. "No one confronted life's struggles with more fortitude or honesty, and as a result, we all learned from the challenges she faced."

Betty Ford underwent surgery for an undisclosed ailment in April 2007. Throughout her years in the White House, 1974 to 1977, she won acclaim for her candour, wit and courage as she fought breast cancer, severe arthritis and the twin addictions of drugs and alcohol. She also pressed for abortion rights and women's rights.

During her husband's term in office, Ford's comments weren't the kind of genteel, innocuous talk expected from a first lady, much less a Republican. Her unscripted comments sparked extensive press coverage and dismayed president Gerald Ford's advisers, who were trying to soothe the national psyche after Watergate. But to the scandal-scarred, Vietnam-wearied, hippie-rattled nation, Ford's openness was refreshing.

But it was her Betty Ford Centre, which rescued celebrities and ordinary people from addiction, that made her famous in her own right. "People who get well often say, 'You saved my life,' and 'You've turned my life around,'" she recalled. "They don't realise we merely provided the means for them to do it themselves and that's all."

The Betty Ford Centre - although most famous for celebrity patients such as Elizabeth Taylor, Johnny Cash and, latterly, Lindsay Lohan - keeps its rates relatively affordable and has served more than 90,000 people.

In a statement on Friday, President Barack Obama said the Betty Ford Centre would honour Ford's legacy "by giving countless Americans a new lease on life."

"As our nation's first lady, she was a powerful advocate for women's health and women's rights," the president said. "After leaving the White House, Ford helped reduce the social stigma surrounding addiction and inspired thousands to seek much-needed treatment."

Candour worked for Betty Ford, again and again. In an era when cancer was discussed in hushed tones and mastectomy was still a taboo subject, the first lady shared the specifics of her breast cancer surgery. The publicity helped bring the disease into the open and inspired countless women to seek breast examinations.

Her most painful revelation came 15 months after leaving the White House, when she announced that she was entering treatment for a longtime addiction to painkillers and alcohol. It turned out the famously forthcoming first lady had been keeping a secret, even from herself.

She and her husband had retired to Rancho Mirage, California, after he lost a bruising presidential race to the Democratic party's Jimmy Carter in 1976. She went to work on her memoirs, The Times of My Life, which came out in 1979. But the social whirlwind that engulfed them in Washington was over, and Betty Ford confessed that she missed it.

"We had gone into the campaign to win and it was a great disappointment losing, particularly by such a small margin," she said. "It meant changing my whole lifestyle after 30 years in Washington, and it was quite a traumatic experience."

By 1978, she was addicted to alcohol and prescription drugs. She would later describe herself during that period as "this nice, dopey pill-pusher sitting around and nodding".

"As I got sicker," she recalled, "I gradually stopped going to lunch. I wouldn't see friends. I was putting everyone out of my life." Her children recalled her living in a stupor, shuffling around in her bathrobe, refusing meals in favour of a drink.

Her family finally confronted her in April 1978 and insisted she seek treatment. She credited their "intervention" with saving her life. "I was stunned at what they were trying to tell me about how I disappointed them and let them down," she said in 1994.

"I was terribly hurt - after I had spent all those years trying to be the best mother, wife I could be... Luckily, I was able to hear them saying that I needed help and they cared too much about me to let it go on," she said.

She entered Long Beach Naval Hospital and underwent a grim detoxification, which became the model for therapy at the Betty Ford Centre. She saw her recovery as a second chance at life. "When you come back from something that was as disagreeable and unsettling as my alcoholism, when you come back to health from that, everything is so much more valuable," she said in her book, A Glad Awakening.

Her own experience, and that of a businessman friend who she helped save from alcoholism, were the inspiration for the centre. She helped raise $3 million, lobbied in the state capital for its approval, and reluctantly agreed to let it be named after her.

"The centre's name has been burden, as well as honour," she wrote."Because even if nobody else holds me responsible, I hold myself responsible." She liked to tell patients, "I'm just one more woman who has had this problem."

Her efforts won her a Presidential Medal of Freedom, the US's highest civilian honour, from the first president Bush in 1991. In 1999 Gerald and Betty Ford both were awarded Congressional Gold Medals.

She continued to be outspoken on public issues, pressing for fellow Republicans to be moderate on social questions. She spoke out in favour of gay people in the military in a 1993 Washington Post interview, saying they had been serving for many years.

A spokeswoman said the family expects to organise a memorial service in Palm Springs over the next couple days. Ford's body will be sent to Michigan for burial alongside her husband.