12 steps and 22 years later

It is possible that Betty Ford wasn’t the only woman to have lived in the White House with a drinking problem. She was certainly the only one to tell the truth about it. Ford’s example -- admitting she had a problem with alcohol and prescription drugs a year after leaving the White House, then checking into a treatment program -- made seeking a remedy for addiction more acceptable, even courageous, especially for women.

Since 1982, the clinic founded by the 20th century’s most candid first lady has been the place that redefined the treatment of addiction. It replaced the image of pickled lowlifes howling and shivering their way through detox with a more enlightened picture. It pioneered gender-specific treatment and acknowledged and treated addiction as a family problem.

Despite the seriousness of its mission, the Betty Ford Center became known as a rehab hideaway for celebrities. Beginning with Elizabeth Taylor in 1983, high-profile people came there not to be coddled, but to get straight. The center and a few other equally sophisticated facilities -- Hazelden Alcohol and Drug Rehabilitation Centers in Minnesota and the Caron Foundation in Pennsylvania -- demand more from their patients than abstinence and the price of admission. Education, medical services and psychological counseling are employed, with an emphasis on not just interrupting but ending a dependence on alcohol and other drugs.

Five years ago, the center’s board of directors agreed that Susan Ford Bales, the only daughter of former President Ford and his wife, Betty, would succeed her mother as chairwoman of the board. It was up to Ford to let them know when she felt ready to step aside. This year, at 86, she did.

It is fitting that the 47-year-old Bales should be the one of Ford’s four children to take over, because, in many ways, she started it all.

Bales was a 19-year-old college dropout when she noticed that her mother’s routine pre-dinner martini and post-prandial bourbon, combined with sleeping pills, pain pills, relaxation pills and pills to counteract the side effects of other pills, had become a problem. “You know, at 19, you’re kind of dumb,” she says. “I was and I wasn’t.”

Bales was blissfully unaware of what a seismic event the family intervention would be. Yet she was smart enough to use professional intervention. The team consisted of a doctor and nurse from the Naval Hospital in Long Beach and Mrs. Ford’s gynecologist, a reformed drinker to whom Susan had gone for advice.

The former president canceled several speaking engagements and flew to join his family, gathered in their home in Rancho Mirage.

Before confronting Betty Ford, the group gathered in Gerald Ford’s office, where the doctor counseled everyone to tell her, lovingly, how they saw her illness affecting and destroying her, and how it hurt them. Susan told the doctor: “I know she’s taking medication for pain, but it makes me angry and worried, and I’m afraid she’ll die.”

“That is what you need to tell her,” he said.

Having personal experience with addiction was life-altering for Bales. She doesn’t plan major transformations for the center but acknowledges that the program must respond to the changing nature of addiction. “The patients are sicker now than they used to be,” Bales says. “A lot of them come in on antidepressants, and some of them leave on antidepressants. Even when alcoholism or drug addiction aren’t the primary problem anymore, there’s often a secondary problem. We’re seeing a very different patient now.”

Bales has been a wife, mother, single parent and stepmother, has co-authored two novels, crusaded for breast cancer awareness and served on the Betty Ford Center board for 12 years. Of all her achievements, she is most proud of spearheading her mother’s intervention.

“It really changed everything,” Bales says, “not only for her, but for so many other people.”

Famous names

From the freeway that shoots through the Coachella Valley east of Palm Springs, you cruise down Bob Hope Drive, past wide boulevards named after Frank Sinatra, Gerald Ford and Dinah Shore, to the Eisenhower Medical Center. The low beige buildings of the Betty Ford Center sprawl over 20 landscaped acres leased from the hospital. The campus looks more like the headquarters of a prosperous corporation than a resort, a jail or an asylum.

There is clearly hard work done here, but some effort has been made to establish a mood of serenity. Patients call a large, still pond with a fountain in its center “the lake.” As pretty as it is, it doesn’t rival the snowcapped San Jacinto Mountains on the horizon, their peaks nestled in fluffy, white clouds.

In the event that the tranquil atmosphere might make addicts feel too comfortable, they’re dramatically reminded how serious their problem is. “When you come in to the Betty Ford Center, you’re told that addiction is a disease that wants you dead, and it will go after you unless you use the tools you learn in the program,” says a former patient who’s been sober since spending a month at the center in 1997.

Every building, sometimes it seems as if every wall, bears the name of a donor. The reception area is dominated by soft-focus portraits of Betty Ford and her friend and co-founder, former U.S. Ambassador Leonard K. Firestone. Upon entering, every visitor must sign in and autograph a confidentiality agreement.

Federal law mandates that licensed drug and alcohol treatment programs must preserve the anonymity of all their patients, famous or otherwise. “We can’t confirm or deny that someone is or has been a patient here,” says John Schwarzlose, the president and chief executive of the center. In charge since opening day 22 years ago, he fired two staff members when he discovered they’d sold information to the tabloids. “Someone who’s been here can tell the world they were at the Betty Ford Center,” he says, “but we can’t.

“It’s not as bad as it used to be, but I’ve had to turn sprinklers on cameramen from the tabloids hiding in the bushes.”

The center’s reputation as a way station on fame’s rocky road has been a mixed blessing. The downside of being known as the last resort of the jet set is that identity sometimes has discouraged regular folks from seeking help there. A teacher in Des Moines might not call, even though 15% of the 154 patients in residence are usually on scholarships. Annually, $4 million from the center’s endowment subsidizes a portion of the $21,000 cost of a month’s stay, for a number of patients.

“Having some well-known people come through here did put us on the map very quickly,” Schwarzlose says. “When we opened, Mrs. Ford thought we’d serve Southern California. But when it would be on the news that so-and-so had been here, it spread our name across the country. Half our patients come from out of state.”

Despite the center’s starry image, the cafeteria has never resembled a studio commissary. Of the 64,000 patients who have passed through the clinic, more than 99% would be unrecognizable to tabloid readers. Nevertheless, in a short time the Betty Ford Center became a synonym for ruling-class rehab. People think that if someone who could afford to go anywhere for help surrenders to the Betty Ford Center, then it must be the best in its class.

Betsy F.’s life was as privileged as any celebrity’s, yet she was 46, malnourished and suicidal when she came to the center eight years ago. (Following the practice of 12-step programs, she insists on remaining anonymous.) Like the regulars at Harry Hope’s saloon in “The Iceman Cometh,” she’d reached the late stage of alcoholism where no matter how much she drank, she couldn’t get drunk anymore.

A graduate of USC, she’d been married for 28 years to the grandson of the founder of a billion-dollar manufacturing company in the Midwest. The couple had four homes, an airplane, full-time staff and money to burn. She’d had years of therapy and tried Alcoholics Anonymous, but she was adept at lying to doctors, and everyone else, about her drinking.

“Wealth can be a great enabler,” Betsy says. “From the outside, I looked great. Size 6, Escada. I could drink as long as I did -- every day for 26 years -- because I didn’t have to drive my kids to school. When we went out at night, we took limos. My husband didn’t really have to work. We could live wherever we wanted. We would buy a house somewhere, and I’d drink so much that after a while we wouldn’t have any friends left, so we’d have to move. I’d wake up in the morning and ask my husband if there was anything I’d done the night before I’d have to apologize for.”

He was her drinking companion, so he might have remembered, or he might not. In the first 13 years of their marriage, the couple moved 15 times -- to San Diego, Denver, Aspen, a small town in Iowa. “Geographic cures,” she calls the moves. “When I finally decided to go somewhere to get help with my disease, the Betty Ford Center was what came to mind. Considering the circles we traveled in, I thought my husband would be more proud of me if I went to Betty Ford, because it was the gold standard.”

It’s odd that the center became known for caring for celebrities and the wealthy, because although therapies are individualized, the center’s philosophy is to handle all patients in the same manner. “Each person is assessed and a treatment plan for that individual is created,” Bales explains. “Some people need to go to grief counseling while they’re here, because someone close to them died while they were still drinking, and they never really grieved for that person. Well, not everybody needs to do that.”

Right now, the Betty Ford Center wouldn’t necessarily be a celebrity’s first choice. More expensive, cushier residential facilities, such as Promises and Passages, both in Malibu, are more likely to accommodate a star’s requests. At Betty Ford, no one, neither NBA team captain nor captain of industry, gets special privileges. No time off is given for going to a movie set or posing for a magazine cover. “We let everyone know they’re here for 30 days, minimum,” Schwarzlose says. “Once you’ve become addicted, getting better has to be the priority.”

Everyone has at least one roommate, gives up telephones and TV and makes his or her own bed. Ford was the model for this nonnegotiable, egalitarian approach. When she went into treatment at the former Naval Hospital in Long Beach, she was in therapy groups with sailors. She had three female roommates.

“We don’t try to compete with the boutique treatment places,” Bales says. “You’re not going to get 360-count sheets here. You aren’t going to get a masseuse. Mother used to say that every one of our patients is a star, but all our stars are equal.”

Betsy recalls, “When I first came to the center, I had a sign on my forehead that said, ‘Don’t you know who I am?’ And the answer was, ‘No, we don’t, and we don’t care. You’re a drunk.’ ”

Upon arrival, new patients are assigned, at random, a “buddy” already in residence to show them the ropes. Betsy was greeted by a tall, heavily tattooed young woman with multicolored hair who looked ready to join a biker gang. “I was this fancy woman from the Midwest,” she says. “I didn’t relate to her at all. But we became fast friends because we had our addiction in common. I was finally in a place where other people knew what my life was really like.”

Celebrities often go through a similar process of adjustment. “Everyone is humbled by the disease,” says Betsy, who later divorced and went on to earn a master’s degree in counseling. She now works at the center.

She never relapsed, but some patients do, including Elizabeth Taylor, who met a future husband when she returned. The center isn’t a prison, and 8% to 10% of those who check in leave within the first five days. “The primary reason they leave is they’re not ready to deal with their addiction,” Schwarzlose explains. “Whatever they say, it all boils down to that.”

So, “I don’t want a roommate” means “I’m not ready to deal with my addiction.” “The food is lousy” means “I’m not ready to deal with my addiction.”

Gender-specific help

Before Betty Ford went public about her problem, the ratio of men to women in treatment for addiction was 3 or 4 to 1 ( 3 to 1 for alcohol, nearly 5 to 1 for illicit drugs). More than half the patients at the center have been women, and Ford sometimes questioned whether the clinic should have served women exclusively.

Women seek help for mental health problems more readily, but addiction is different. Schwarzlose says, “As a society, we still put more obstacles in the way of women getting help than we do for men. A middle-class man will say, ‘My boss wants me to get treatment, I’m going to Betty Ford.’ If a woman says she’s going into treatment, her husband says, ‘Who’s going to take care of the kids?’ ”

More than half the women who come to the center have been abused at some time in their lives -- sexually or physically -- a key reason the center turned to gender-specific treatment. In many cases, abusing alcohol and drugs became a way of coping. “For a woman in a coed group to say, ‘Twenty years ago, my uncle raped me,’ isn’t easy,” Schwarzlose says. “It isn’t an easy thing to say in a women’s group, but with men present, it’s even more difficult.”

At first, the center had a 20-bed women’s residential unit, 20 beds for men and two dormitories that were coed. In 1988, when comparisons made it obvious that both genders did better when segregated, coed units were disbanded.

According to federal government studies, 15 million Americans are addicted to alcohol, 12 million to other drugs. The marketplace presents an ever-changing array of chemicals people can abuse. Yet alcoholism is and always has been the No. 1 problem people seek treatment for at the Betty Ford Center. When the center first opened, Valium was the second most abused drug, then cocaine surpassed it. Now opiates such as Vicodin, Percoset and OxyContin, usually legally prescribed, are in second place.

Until last year, Betty Ford, who lives with the former president half a mile away behind the gates of the Thunderbird Country Club, would lecture to patients once a month. She talked about her addiction and explained how she got well. Counselors would sometimes ask her to come talk with a patient who was still in denial.

Schwarzlose says, “Mrs. Ford loved being asked to do that. It would often be an older patient, someone who might be a member of a country club who would say, ‘I know I drink too much, but I still have my home.’ She could get through to them better than anyone.

“ ‘It doesn’t matter that you’re a member of the country club,’ she would say. ‘I was in the White House.’ ”