Substance Abuse, CTE & Secrecy in the NFL

The NFL faces a silent crisis of substance abuse and chronic traumatic encephalopathy (CTE) among its players, stemming from repeated head trauma and the league’s historical secrecy regarding these risks. Many players battle addiction to painkillers, often overprescribed to keep them on the field, which can worsen CTE symptoms and lead to severe mental health issues, including increased suicide rates. While the NFL has implemented some interventions, there’s a critical need for greater transparency, accountability, and comprehensive support for players’ long-term health and wellbeing.

As of Autumn 2025, the NFL season is in full swing, and millions are glued to their screens every Sunday. But behind the roaring crowds and highlight-reel plays, a silent crisis continues to plague both current and former players: the intersected epidemics of substance abuse in the NFL and chronic traumatic encephalopathy (CTE). While the league generates billions, many players are left battling addiction and the devastating effects of repeated head trauma, often in silence. Read on to learn more about the factors that contribute to this crisis, the role of NFL secrecy, and what can be done to address it.

The Crushing Reality of NFL Brain Injuries and CTE

The foundation of this crisis lies in the brutal reality of professional football: repeated head trauma. NFL CTE, or chronic traumatic encephalopathy, is a degenerative brain disease caused by repeated blows to the head. Unlike a single, catastrophic injury, CTE develops slowly, often over years, as misfolded tau proteins accumulate in the brain, leading to neurodegeneration.

The sheer number of head impacts is staggering. One study has shown that during a four-year high school football career, the average lineman sustains almost 3,500 head impacts. These numbers escalate dramatically at the collegiate and professional levels, where athletes are bigger, faster, and collisions are more violent. It’s not just the highlight-reel knockouts; it’s the constant barrage of subconcussive hits that occur in every practice and game that contribute to football brain damage.

The prevalence of CTE among former NFL players is alarming. A 2023 study by Boston University found CTE in 345 of 376 (91.7%) brains of deceased former NFL players donated for research. While this doesn’t mean that nearly all current and former NFL players have CTE, as brain bank samples can be skewed, it undeniably demonstrates the significant occupational risk.

One of the most frustrating aspects for players is the diagnostic uncertainty. Can CTE be diagnosed in living NFL players? The answer is a definitive no. CTE can only be confirmed through postmortem examination. This leaves players suffering from cognitive decline, memory problems, depression, and aggression in a diagnostic limbo, unable to receive a definitive diagnosis during their lifetime. A 2023 Harvard study revealed that approximately 34 percent of nearly 2,000 former NFL players believe they have CTE. This highlights the real suffering and legitimate neurological concerns, as well as the diagnostic uncertainty that haunts former players.

NFL Secrecy: A History of Denial and Suppression

The NFL’s response to the growing evidence of brain injury risks has been fraught with NFL secrecy. When did the NFL first know about CTE risks? Evidence suggests the league was aware of potential neurological complications from head trauma far earlier than it publicly acknowledged.

As early as the 1970s, lawsuits and media attention highlighted institutionalized drug abuse in professional football. Players alleged that teams administered amphetamines, barbiturates, and other performance-enhancing substances without informed consent, masking pain from serious injuries. Former St. Louis Cardinal Dave Meggyesy even described NFL trainers as “dealing drugs,” distributing amphetamines, narcotic analgesics, and steroids to keep players on the field.

When Dr. Bennet Omalu published his groundbreaking 2005 case report describing CTE in former NFL player Mike Webster, the NFL initially attempted to discredit his findings. This became a pattern of NFL secrecy regarding head injury risks, with the league even forming the Mild Traumatic Brain Injury (MTBI) Committee in 1994, which was later criticized for its methodological limitations that minimized concussion severity and long-term risks.

It wasn’t until 2014, during a congressional roundtable, that an NFL senior vice president acknowledged a link between football and neurodegenerative diseases, including CTE. This admission came only after years of denial and obfuscation, and significantly, after the framework for a landmark legal settlement had already been constructed.

The Opioid Crisis: Pain Management and the Path to Addiction

Beyond the direct impact of head injuries, the NFL’s prescription painkiller use and addiction crisis represents another significant threat to player health. Research has shown that retired NFL players misuse opioid pain medications at a rate more than four times greater than the general population. A study published in Drug and Alcohol Dependence found that 52 percent of retired NFL players surveyed reported using prescription pain medication during their careers, and of those, 71 percent admitted to misusing them.

The pressure to return to the field often leads to the overuse and overprescription of painkillers. Players routinely suffer injuries requiring surgical intervention or extended rehabilitation. Team physicians, incentivized to keep players competing, often manage pain pharmacologically, sometimes prioritizing short-term performance over long-term health. Medications like Toradol, while effective, can have severe side effects when used chronically. When Toradol proves insufficient, opioids become the default intervention.

Former New York Jets quarterback Ray Lucas described how team medical staff prescribed him opioids instead of authorizing a costly neck surgery, escalating his usage to 1,400 pills per month. Hall of Famer Brett Favre admitted to taking as many as 14 Vicodin tablets simultaneously during the 1995 season. This highlights how elite performance and opioid dependency can become intertwined.

The consequences of this early exposure to opioids are long-lasting. Players who misused prescription painkillers during their careers are approximately three times more likely to misuse them during retirement. This creates a vulnerable population of aging, injured former players at risk of overdose, hepatitis C, and even death.

The Deadly Intersection of Substance Abuse and CTE

How does NFL substance abuse worsen CTE in football players? The answer lies in a complex interplay of biological and behavioral factors. Opioid use impairs cognitive function, independently of any underlying brain injury. It alters brain chemistry, leading to cognitive dulling, memory impairment, and emotional dysregulation. These are symptoms that can mimic or exacerbate CTE.

Opioid addiction often co-occurs with depression, a condition already prevalent among players with a history of concussions. Studies show that players with three or more concussions are three times more likely to be diagnosed with clinical depression. This can lead to a dangerous cycle of self-medication with opioids, further compounding the problem.

Perhaps most tragically, chronic opioid use impairs judgment and executive function, preventing players from seeking appropriate medical care for their brain injuries. A player struggling with addiction may prioritize drug procurement over medical evaluation, lacking insight into the severity of their neurological deterioration.

The suicide rate among former NFL players with CTE is a stark reminder of the devastating consequences of this intersection. A Harvard study found that 34 percent of former NFL players who believed they had CTE also reported suicidal ideation. The combination of impaired executive function, despair related to cognitive decline, and opioid use creates an extraordinarily dangerous scenario.

The tragic deaths of players like Junior Seau, Tom McHale, and Dave Duerson serve as heartbreaking examples of this deadly intersection.

Moving Forward: Prevention, Treatment, and Accountability

The NFL has implemented some interventions to reduce head impact risks, including rule changes, equipment innovations, and the NFL Concussion Protocol. However, is the NFL doing enough to prevent head injuries? The answer is likely no. While incremental improvements are occurring, the disease itself is not being prevented.

What’s needed? The NFL needs to prioritize player health and safety above all else. This includes

• Investing in research to improve CTE diagnosis and treatment
• Strengthening concussion protocols and ensuring adequate recovery time
• Addressing the root causes of opioid addiction, including pain management practices and mental health support
• Providing comprehensive support for retired players, including access to substance abuse treatment and mental health services
• Continuing to refine the NFL drug testing policy effectiveness and loopholes to ensure it prioritizes prevention and early intervention

The legal settlements against the NFL for concussions represent a step towards accountability, but they are not a complete solution. The league must take proactive steps to protect its players, both during and after their careers.

The stories of players like Brett Favre, Josh Gordon, Aldon Smith, and Darren Waller offer both cautionary tales and beacons of hope. They highlight the complex challenges of NFL substance abuse and the potential for recovery. The recent death of Doug Martin and the arrest of former Jets QB Mark Sanchez are bringing more attention to the NFL and substance abuse.

If you or someone you know is struggling with substance abuse or mental health, Mountainside can help with unique and individualized therapies that meet you where you are. Speak with an admissions counselor today to see what your options are.