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In 1989, Cindy McCain developed an addiction to Percocet and Vicodin. She initially took the opioid painkillers to alleviate pain after two spinal surgeries for ruptured discs. She also used the drugs to ease emotional stress during the Keating Five affair. The addiction progressed to where she was taking upwards of twenty pills a day, and she resorted to having an AVMT physician write illegal prescriptions in the names of three AVMT employees without their knowledge. In 1992, her parents staged an intervention to force her to get help she told her husband about her problem, attended a drug treatment facility, began outpatient sessions and ended her three years of addiction. In 1993, she underwent surgery, which resolved her back pain.

In January 1993, Tom Gosinski, an AVMT employee who had discovered her illegal drug use, was terminated on budgetary grounds. Subsequently, he tipped off the Drug Enforcement Administration about her prior actions and a federal investigation ensued. McCain’s defense team, led by John McCain’s Keating Five lawyer John Dowd, secured an agreement with the U.S. Attorney’s office for McCain, a first-time offender, which avoided charges while requiring her to pay financial restitution, enroll in a diversion program and do community service. Meanwhile, in early 1994, Gosinski filed a wrongful termination lawsuit against McCain, in which he alleged she ordered him to conceal “improper acts” and “misrepresent facts in a judicial proceeding”; he told her he would settle for $250,000. In response, Dowd characterized this request as blackmail, and requested Maricopa County attorney Rick Romley to investigate Gosinski for extortion. In the end, Gosinski’s credibility was undermined by testimony in Romley’s report from other charity staffers who asserted Gosinski privately vowed to blackmail McCain were he ever fired,and both Gosinski’s lawsuit and the extortion investigation against him were dropped.

Knowing that prosecutors were about to publicly disclose her past addiction, McCain preemptively revealed the story to reporters, saying that she was doing so willingly: “Although my conduct did not result in compromising any missions of AVMT, my actions were wrong, and I regret them ... if what I say can help just one person to face the problem, it’s worthwhile.”