WASHINGTON — When Cindy McCain is asked what issues she would champion if she became first lady, she often cites one of the most difficult periods of her life: her battle with — and ultimate victory over — prescription painkillers. Her struggle, she has said repeatedly, taught her valuable lessons about drug abuse that she would pass on to the nation.

“I think it made me a better person as well as a better parent, so I think it would be very important to talk about it and be very upfront about it,” McCain said in an interview with “Access Hollywood.” In an appearance on the “Tonight Show with Jay Leno,” she said she tries “to talk about it as much as possible because I don’t want anyone to wind up in the shoes that I did at the time.”

In describing her struggle with drugs, McCain has said that she became addicted to Vicodin and Percocet in early 1989 after rupturing two disks and having back surgery. She has said she hid her addiction from her husband, Sen. John McCain, and stopped taking the pain medications in 1992 after her parents confronted her. She has not discussed what kind of treatment she received for her addiction, but she has made clear that she believes she has put her problems behind her.

While McCain’s accounts have captured the pain of her addiction, her journey through this personal crisis is a more complicated story than she has described, and it had more consequences for her and those around her than she has acknowledged.

Her misuse of painkillers prompted an investigation by the Drug Enforcement Administration and local prosecutors that put her in legal jeopardy. A doctor with McCain’s medical charity who supplied her with prescriptions for the drugs lost his license and never again practiced medicine. The charity, the American Voluntary Medical Team, eventually had to be closed in the wake of the controversy. Her husband was forced to admit publicly that he was absent much of the time she was having problems and was not aware of them.

“So many lives were damaged by this,” said Jeanette Johnson, whose husband, John Max Johnson, surrendered his medical license. “A lot of good people. Doctors who volunteered their time. My husband. I cannot begin to tell you how painful it was. We moved far away to start over.”

McCain’s addiction also embroiled her with one of her charity’s former employees, Tom Gosinski, who reported her drug use to the DEA and provided prosecutors with a contemporaneous journal that detailed the effects of her drug problems. He was later accused by a lawyer for McCain of trying to extort money from the McCain family.

“It’s not just about her addiction, it’s what she did to cover up her addiction and the lives of other people that she ruined, or put at jeopardy at least,” Gosinski said in an interview this week.

Cindy and John McCain declined repeated requests to be interviewed for this article. The McCain campaign also declined to comment.

Based on the limited details they have provided in earlier interviews, it is impossible to tell the full story of a difficult period in their lives. The following account of Cindy McCain’s prescription drug abuse and her and her husband’s efforts to deal with it is based on official records, including a report by the county attorney’s office in Phoenix, and on interviews with local and federal officials involved in the probe.

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In 1988, during her husband’s first Senate term, Cindy McCain founded the American Voluntary Medical Team, a nonprofit that sent volunteer doctors and nurses to provide free medical care in Third World countries and U.S. disaster zones. Cindy McCain served as president, operating out of her family’s business, a giant Anheuser-Busch beer distributorship in Phoenix owned by her father.

The McCains had married in 1980. They moved to Washington after he was first elected to the House of Representatives in 1982. But she later returned to Phoenix, her home town, believing it was a better place to raise a family. Sen. McCain commuted home on weekends.

Even far from Washington, politics took a toll on Cindy McCain. In 1989, she was pulled into a Senate investigation that focused on her husband and four other senators who had intervened with regulators on behalf of savings-and-loan owner Charles Keating.

When questions arose about a vacation the McCains took to Keating’s home in the Bahamas, Cindy McCain, as family bookkeeper, was asked to document that they had reimbursed the Keatings, but she could not. She has repeatedly cited the stress of the Keating Five scandal and pain from two back surgeries that same year as reasons for her dependence on painkillers.

Her charity, AVMT, kept a ready supply of antibiotics and over-the-counter pain medications needed to fulfill its medical mission. But it also secured prescriptions for the narcotic painkillers Vicodin, Percocet and Tylenol 3 in quantities of 100 to 400 pills, the county report shows.

McCain started taking narcotics for herself, the report shows. To get them, she asked the charity’s medical director, John Max Johnson, to make out prescriptions for the charity in the names of three AVMT employees.

The employees did not know their names were being used. And under DEA regulations, Johnson was supposed to use a special form to notify federal officials that he was ordering the narcotics for the charity. It is illegal for an organization to use personal prescriptions to fill its drug needs.

“The DEA told me it was OK to do it that way,” Johnson told The Washington Post recently, in his first media interview about the case. “Otherwise, I never would have done it.”

The county report showed that Johnson told officials he knew it was wrong, but he wrote prescriptions at McCain’s request at least twice.

After Johnson wrote the prescriptions, McCain, and sometimes her secretary, picked them up from his home. Once they were filled, Johnson was supposed to maintain custody of the narcotics, but he said he let McCain control them and carry the medications in her luggage on charity trips.

No one tracked the narcotics in between the charity’s missions, the county report shows.

When the county investigator asked Johnson where the charity stored its narcotics, he said they were in a safe. When asked where the safe was located, Johnson said he had never seen it.

Officials with other medical charities contacted by The Post said it is unusual to distribute narcotics overseas, particularly in Third World countries where medical teams treat disease and infection rather than performing painful surgeries.

Some of the doctors and nurses who went on McCain’s missions said they never saw narcotics on AVMT trips and would have discouraged carrying such medications. “You don’t bring narcotics into a foreign country, especially with people who have machine guns around,” said Michele Stillinger, a nurse during a 1991 AVMT mission to Bangladesh.

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Tom Gosinski, then 32, met Cindy McCain while working for America West Airlines and coordinating an AVMT flight to Kuwait. She hired him in 1991.

He grew close to the McCain family. He knew the domestic staff, as well as Cindy’s father, James, and mother, Marguerite.

Thinking he might one day write a book, Gosinski kept a journal that he later turned over to investigators. His entries about AVMT suggest that McCain’s behavior led employees to believe she was using drugs.

“Right away, I noticed the mood swings,” Gosinski told The Post in June. “She wouldn’t show up at the office, and we’d call her home. Her house staff would say she hadn’t come out of her room yet. It would be 11 a.m. or noon.”

As time wore on, his diary chronicled office concerns that McCain was taking pills from the charity’s inventory. Gosinski developed a code for her behavior, the county report shows. On days when his boss appeared to be in a good mood, he called wrote “OP,” for “On Percocet.” Bad days were called “NOP,” for “Not on Percocet.”

On July 20, 1992, he wrote, “I really don’t know what is going on but I certainly hope that Cindy does not get herself of (sic) AVMT in trouble.”

A relative of McCain’s told charity staff members that McCain’s parents planned to confront her about her addictive behavior, according to the journal. McCain has said they did so in late 1992, asking whether painkillers were causing her “erratic” conduct. Gosinski’s journal indicates he heard about the confrontation the next day, Oct. 2, 1992.

McCain’s relationship with Gosinski soon deteriorated. In January 1993, she ordered him to stop gossiping about her, Gosinski said. Soon after, she fired him but wrote him a glowing termination letter.

Gosinski eventually returned to America West as a travel consultant and worked part-time as a bookstore clerk.

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Three weeks after his firing, Gosinski contacted Phoenix DEA agents and gave them a copy of his journal.

The DEA questioned the charity’s doctors, and McCain hired John Dowd, a powerhouse Washington lawyer, to represent AVMT. Dowd had defended John McCain in the Keating Five scandal, helping the senator win the mildest sanction of the five senators involved. Dowd declined to comment for this article.

Soon, the DEA began looking at McCain. Dowd informed Johnson, the physician, that “there’s been further investigation and Cindy’s got a drug problem,” Johnson told county investigators.

The DEA pursued the matter for 11 months. Dowd kept tabs on the investigation from Washington, writing letters and making frequent phone calls to the agency, according to sources close to the investigation.

McCain’s conduct left her facing federal charges for obtaining “a controlled substance by misrepresenting, fraud, forgery, deception or subterfuge.” Experts say she could have faced a 20-year prison sentence.

Dowd negotiated a deal with the U.S. attorney’s office allowing McCain, as a first-time offender, to avoid charges and enter a diversion program that required community service, drug treatment and reimbursement to the DEA for investigative costs. Johnson agreed to surrender his medical license and retire.

With final negotiations between federal prosecutors and Dowd still under way, Gosinski sued McCain for wrongful termination.

On Feb. 4, 1994, Gosinski’s attorney, Stanley Lubin, wrote to McCain, saying his client had omitted certain details in his lawsuit “due to their sensitive nature.” He said that for $250,000, Gosinski would drop the action. Lubin said in an interview that he met with Dowd, who said the lawsuit was without merit. “He told me if I thought the senator was going to cave into this extortion, I was going to learn a very serious lesson,” Lubin recalled.

On April 28, 1994, Dowd wrote to Maricopa County Attorney Richard Romley, a Republican, asking that Gosinski be investigated for attempted extortion.

Romley agreed. Dowd and Cindy McCain lined up witnesses and prepared a brief to support the contention that Gosinski’s job performance was unacceptable and that he was of questionable character, assertions he denied.

In May of that year, county investigator Terry Blake interviewed McCain at her Phoenix home. He asked questions about Gosinski and then grilled McCain about prescription painkillers. He later wrote:

“Mrs. McCain was asked if AMVT procured narcotic drugs as a part of their normal operation. She said they did.

“I asked if she ever obtained narcotic drugs by using her employee’s names. She said she did.

“Mrs. McCain was asked if prescriptions were written in Mr. Gosinski’s name without his knowledge. She said yes.”

McCain told Blake she once had a dependence on painkillers, according to the report, which included the interview summary and copies of her illegal prescriptions. The probe of possible extortion by Gosinski was closed without charges.

After the case was closed, prosecutors told McCain’s lawyer that they would make the report public. Before it was released, Sen. McCain dispatched Jay Smith, then his top strategist, to Phoenix to line up interviews between Cindy McCain and journalists from four select media outlets who were unaware of the report. Smith did not include two news organizations that had learned about the report, the Arizona Republic and New Times, an alternative weekly in Phoenix.

McCain told the reporters that she was stepping forward willingly. “If what I say can help just one person to face the problem, it’s worthwhile,” she said.

Two reporters wrote that McCain said she had completed a drug treatment program at The Meadows, a facility in Wickenberg, Ariz., as part of the agreement with federal prosecutors. But days later, federal officials said that no agreement had been reached and that she had not yet been accepted into a diversion program, which would include approved treatment. McCain issued a statement saying the reporters erred, but she did not disclose details of her treatment.

The only public reference to treatment is her mention in the county investigator’s report of a one-week stay at The Meadows.

Once the county report was released, along with Gosinski’s journal, a few reporters challenged McCain’s account. Only New Times published excerpts from Gosinski’s diary. Within a few weeks, the story died in Arizona, without receiving national exposure. Gosinski ultimately ran out of money and let his lawsuit against McCain die.

Gosinski, who has moved to Nebraska, was initially reluctant to tell his story when contacted by The Post in May. He is still viewed with enmity by some in the drug investigation, including the Johnsons, who hold him responsible for the doctor’s troubles.

He eventually gave several lengthy interviews and provided The Post with a copy of his journal. He subsequently cut off contact and asked that his name not be printed, saying he became frightened by the prospect of facing the McCain campaign on his own.

On Wednesday, he said he had changed his mind. He appeared at a news briefing in Arlington, Va., set up by a Democratic Party consultant. Gosinski, a registered Republican, said that he sought help orchestrating a single media event because so many reporters wanted his story, but that he has had no contact with the Obama campaign or the Democratic National Committee.

He also signed an agreement with the Center for Responsibility and Ethics in Washington, a D.C.-based watchdog group, which will provide legal representation for him in the event of a lawsuit.

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McCain’s drug use became national news during her husband’s first presidential campaign in 2000. Newsweek published a first-person account of her struggle, but it included some errors.

“It began with Vicodan (sic). In 1989, I had ruptured a couple of disks carrying my 1-year-old, Bridget, in a pack on my back,” she wrote.

But Bridget was not born until 1991. In other accounts, McCain said she hurt her back while picking up her son Jimmy, who was a toddler at the time of her injuries.

As the McCains traveled in the “Straight Talk Express” bus in 2000, interest in Cindy McCain’s story faded when it became clear that she and her husband weren’t headed for the White House.

This year, as the McCains campaigned again, Cindy McCain granted interviews about her past problems to “Access Hollywood” and Jay Leno. She called her addiction a life-changing crisis.

“Your life experiences make you,” she told “Access Hollywood,” “and hopefully you learn from them.”