Concert appearances became a few guest appearances for wife June Carter Cash's shows.
But while the Man in Black has had his share of such problems, he was and is far from down and out.
Far from it as evidenced by "American III: Solitary Man," his third album with producer Rick Rubin, released by American Recordings through Sony in October.
Cash, who was in the hospital several times in 1998 with a then-diagnosed case of Shy Drager Syndrome, a debilitating and eventually fatal disease, bounced back a year ago to hit the recording studio.
Recording some in Nashville starting in the fall of 1999 and later at The Akademie Mathematique of Philosophical Sound Research, aka the Los Angeles-area home of Rubin, the new disc contains 14 songs.
Some are covers - U2's "One," "I Won't Back Down," penned by Tom Petty and Jeff Lynne for a Petty solo album, "The Mercy Seat," by Nick Cave and Mick Harvey - while 6 of the 14 were written at least in part by Cash.
A host of well-known musicians participated as well, including Tom Petty, Sheryl Crow, Merle Haggard, June Carter Cash, Marty Stuart and Mike Campbell and Benmont Tench from The Heartbreakers.
Guitarist Randy Scruggs, who played on many songs, says, "He was wanting to keep this very very simple - two guitarists, two instrumentalists along with Cash. Sometimes it was just me and him."
"I think he wanted someone that he had respect for as far as their abilities on the instrument as well as (musicians who) really understood him artistically and hopefully would add to that. All these other artists - Norman Blake and Marty -understood that and have these other abilities."
Participating in the album was no surprise for Scruggs, known as a session guitarist and producer in Nashville. He just produced Loretta Lynn's latest.
"Johnny called me," says Scruggs, son of bluegrass great Earl of his involvement. "I've known him since I was probably around 10 years old literally. Some of the most important artists in my own musical upbringing - family friends of ours were the Carter Family and Johnny Cash. I've known him all my life."
"We've been involved in career situations a number of different ways. I have produced a couple of sides that were in previous projects, and I have played (with him) before."
Rubin, better known for his work with the likes of The Black Crowes and Rage Against the Machine - not exactly country bands, first hooked up with Cash for 1994's "American Recordings," earning a Grammy for best contemporary folk album. The disc featured "Delia's Gone."
Three years later, "Unchained" took home best country album, even though Cash received zippo airplay from country radio, a slap in the face to the Nashville establishment.
Rubin, who started American, hooked up with Cash through his long-time manager, Lou Robin, in 1993.
"I had heard of him - that he had been successful with the type of music that he was doing, and I gave him a call," Robin says in an interview from his New York City hotel room. "I heard what he was up to through mutual friends. He was hitting it very big at that point. Granted, it was not the same music that John did. I think Rick was expanding his horizon and scope of activity."
Robin says, "Rick had professed an interest in meeting John and recording him because he was a fan of his music and the integrity of his music. I had talked with Rick and arranged for him to come to a concert in Santa Ana, Cal. that Johnny was doing."
The two met in Cash's dressing room.
"I think they just stared at each other at first to size each other up - Rick with the long hair, and John meeting Rick, and Rick meeting John," recalls Robin.
Despite their differences, Robin says Cash was interested in working with Rubin due to "the fact that he was excited about the prospects and that it was new and intriguing."
Cash was not exactly coming through a stellar recording period. His albums did not chart highly for Columbia. Going to Mercury did not seem to help much either.
"We had gone through producers and labels, and nothing had jumped out that was any different than what we had been going through," says Robin. "This was a breath of fresh air. So, I would not have discouraged that."
"They started chatting, and they found they found they had tremendous meeting ground," says Robin.
"He said, 'how would you record me different than anything one else?'" Robin says Cash asked.
"I'd like you to sit down and keep playing,'" Robin says of Rubin's response. "That's how it all it all began."
"Many record producers had their preconceived notions, which could or could not be compatible with what John wanted to do," Robin says.