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OTL: Concussions may impact drug use

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STUDY: PLAYERS MISUSE PAINKILLERS First scientific study of prescription painkiller use by retired NFL players shows higher rates of misuse than the general population. PAINKILLER USE IN TODAY'S NFL Pain and painkillers are commonplace for many NFL players, though league and medical staffs have tightened up access. CONCUSSIONS MAY IMPACT DRUG USE ABOUT THE PAINKILLERS STUDY ESPN commissioned the first-of-its-kind study, and the National Institute on Drug Abuse joined as a partner. ADDITIONAL RESOURCES Learn about painkiller misuse resources and treatment options, and view additional video clips and photos.

CONCUSSIONS MAY IMPACT DRUG USE Scientific data are unclear about whether years of head trauma could contribute to painkiller misuse, but one widow believes concussions could explain her husband's uncharacteristic behavior.

AMPA, Fla. - Lisa McHale feared for her husband's life. It was May 2008, the Friday before Memorial Day weekend. She stood before a Tampa-area court clerk seeking a judge's order to have her husband, Tom, involuntarily committed to a state-run drug treatment facility.

Tom McHale, an offensive guard and tackle who played nine years in the NFL, had battled a destructive addiction to prescription painkillers for years. Just days before that May weekend, though, he'd crossed another barrier, using cocaine inside his home. Concerned about her husband's reckless behavior and the impression it might leave on the couple's three young boys, Lisa McHale told her husband to leave.

He did. But given his erratic behavior, Lisa soon worried about his safety. Under Florida's Marchman Act, Lisa knew she was within her spousal rights to have Tom picked up and placed into drug treatment, even against his will. But she was running out of time to petition the court, because the courthouse was about to close for the holiday weekend.

"I felt like if he walked into a pain clinic, they'd give him a prescription for OxyContin … and [he'd] be dead," Lisa told ESPN's "Outside the Lines."

"The [clerk] looked at me and said, 'The judge is still in chambers. He can take your case, but I don't think there are any beds. It may have to wait until Tuesday.' And I looked at her and I said 'I think Tuesday might very well be too late.'"

Ultimately, the judge signed an order to have Tom committed.

The commitment marked another step in the long battle the McHales faced with his addiction. Lisa always struggled to reconcile Tom's drug use with the man she thought she knew. Only later would she come upon a discovery that would give her some explanation: That perhaps the years of head trauma Tom suffered as an NFL player contributed to his irrational behavior.

'He was losing his mind'

Lisa spoke with Tom on the phone the night she secured the court order. It was their eldest son T.J.'s birthday. She told Tom about the order to force him into treatment, but he balked.

"We had a very short conversation," she said. "I said, 'I'll talk to you tomorrow, and we'll see how things are.' We hung up and he said, 'I love you,' and I said, 'I love you too, Tom … '"

Eager to get away, Lisa took her sons to a friend's home in Jacksonville. On Sunday morning, she received another phone call. Tom was dead -- an accidental drug overdose, according to police. He was 45.

"When he died, he had a prescription of OxyContin from a pain clinic," Lisa said, her voice cracking as she recalled the final hours of her husband's life.

Tom, police later discovered, had OxyContin, alcohol and cocaine in his system when he died in his sleep inside the Tampa-area apartment of a friend with whom he'd once attended drug treatment.

"He was out of control," Lisa said of her husband of 18 years. "He was losing his mind."

Drug use linked to head trauma?

The day after Tom's death, Lisa received a phone call from researchers affiliated with Boston University's School of Medicine. They had an unusual request. They wanted Tom's brain for their ongoing research into chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by head trauma.

At that point, Dr. Ann McKee, a neuropathologist at the Veterans Affairs Medical Center in Bedford, Mass., and her colleagues at Boston University had discovered the presence of CTE in the brains of five deceased NFL players. CTE has been linked to head trauma and shown to cause dementia-like symptoms even in people in their 40s and 50s.

As the daughter of a doctor, Lisa believed in the importance of donating organs for scientific research, but she was convinced researchers wouldn't find any evidence of CTE in her husband's brain.

"I said: 'You're not going to find what you're looking for 'cause Tom didn't have concussions that I know of,'" she said. "I never expected them to find anything."

What McKee found when she examined Tom's brain in December 2008 was an advanced case of CTE, particularly in the areas of the brain known as the frontal cortex and the amygdala. According to McKee, both regions are responsible for impulse control.

"[Tom] had pretty extensive disease, so his amygdala was damaged, so was his frontal cortex," McKee said. "He was dealing with a large pathological burden. … You see all this damage, and now you get a sense what Tom was struggling with." McKee said the damage to Tom's brain was consistent with what she'd discovered in the brains of other football players who'd suffered years of head trauma.

She described the frontal cortex as part of the brain's "super ego."

"It's why you behave in society in a responsible way," McKee said.

With so much damage to that region of his brain, McKee said, Tom may have been more inclined to abuse prescription pain medication and other harmful drugs.

"My sense is he would have been affected in all the ways that frontal cortex damage affects you. It's not only impulse control it's judgment. [Tom] made poor decisions more easily. He may have been unable to resist certain things that made him feel better, like drugs or alcohol, just because he had extensive damage in the frontal cortex."

The news of Tom's brain damage stunned Lisa.

"Never once, for one iota, did I ever expect it had anything to do with head trauma, and neither did [Tom]," she said.

"It just breaks my heart that much more to know what he was up against and what he must have been feeling."

When asked whether Tom's drug abuse could be linked directly to the presence of CTE, McKee said, "The evidence points to it but it doesn't prove it."

McKee said Tom's case adds to the mounting evidence that even the thousands of sub-concussive blows caused by the collisions a football player experiences in a career can lead to CTE.

A recent scientific study conducted by researchers at Washington University's School of Medicine found additional examples of undiagnosed concussions and the misuse of prescription pain medication.

Co-sponsored by ESPN and the National Institute on Drug Abuse, the phone survey of 644 former NFL players was conducted between March and August 2010 and led by Linda Cottler, a professor of epidemiology in Washington University in St. Louis's Department of Psychiatry. The study included NFL players who retired between 1979 and 2006 and who played, on average, for more than seven years.

Of those retired players who admitted to misusing prescription painkillers within the past 30 days, 98 percent said they suffered from undiagnosed concussions compared with 79 percent for those players who did not currently use prescription pain medication.

Among the many factors considered in the study, researchers found undiagnosed concussions to be "the strongest predictor of misuse" of prescription painkillers.

"The person who had an undiagnosed concussion was three-and-a-half times more likely to be a current misuser [of prescription pain medication] than a person who didn't have an undiagnosed concussion," said Cottler.

A wife searches for answers

For Lisa, the knowledge that her husband's drug abuse could be linked to head trauma offered scant comfort.

She met Tom when the two attended Cornell University. She was 19. Tom was 23. "I feel like I grew up with him. He was truly my best friend. He was one of the most amazing people I've ever known."

Tom studied hotel management and later, after his NFL career, became a fixture in the Tampa area, opening up McHale's Sports Pub and McHale's Chop House.

In 2005, Tom admitted to Lisa that he'd been abusing the prescription painkiller OxyContin. While she's uncertain of the precise date Tom's drug abuse began, Lisa suspects it started as far back as 2003.

Tom's admission prompted a series of failed attempts at inpatient and outpatient drug therapy. Through it all, Lisa said she continued to notice a change in her husband. The gregarious and goal-oriented man she married was replaced with a person who frequently became "restless, irritable and discontent."

"When the drugs were out of his system … I didn't see him getting any better. I still didn't see my Tom returning. And it was just scaring the hell out of me. I knew something else was going on."

Gay Culverhouse, the daughter of former Tampa Bay Buccaneers owner Hugh Culverhouse, remembered Tom, who played for the Bucs from 1987 to 1992, as the "guardian angel" who protected her teenage daughter from the advances of several Buccaneers rookies.

"Tom McHale was not a drug abuser. There had to be some deeper problem," Culverhouse said.

Today, Culverhouse runs the Gay Culverhouse Players' Outreach Program, which helps retired players cut through the red tape of the NFL's disability system. She said she's aware of multiple cases like Tom's, in which family members of retired NFL players have had to seek court orders to have their loved ones committed for psychological and drug treatment.

"A lot of these players don't know what's happening to them, so they self-medicate," Culverhouse said.

For years, Lisa searched for answers for the roots of her husband's drug abuse. Tom's use of highly addictive drugs was out of character.

"Tom was not a partier. Every Saturday night we went out, we had a sitter, and every other night of the week he was home," she said.

After years of failed attempts at rehab, Lisa said, Tom eventually supplemented his prescription painkiller use with recreational drugs to avoid the painful withdrawal symptoms.

"He was not taking the prescribed doses, and what would happen is he would run out before the month was out. … He was going through cycles of withdrawal and then ultimately that's when cocaine got involved because he found that cocaine could get him through that period of withdrawal," she said.

"It seemed like every time he relapsed, every time drugs were reintroduced into his system, he was that much less rational."

Despite that, on the final night of his life, Tom still spoke about getting clean.

"He was actually with a friend who had been in treatment. … And they had a conversation and he said 'I know I need to do what the doctor is saying. And I'm gonna go, I'm gonna go get help,'" she said.

A short time after that conversation, Tom went to sleep and never woke up.

Lisa now works part-time doing family outreach for the Sports Legacy Institute, an organization affiliated with Boston University that promotes concussion-prevention awareness and the study of CTE.

Part of her job is to counsel families who have made the difficult decision to donate a deceased loved one's brain for research.

Reflecting, she's convinced it was the CTE in her husband's brain that led to his death.

"He didn't die of drug abuse because he was a 'druggie' who became addicted," Lisa said. "I believe it was 100 percent the interaction of drugs on a very diseased portion of the brain."

John Barr is a reporter in ESPN's Enterprise Unit. He can be reached through email jbarr-espn@hotmail.com.

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ALSO IN THIS SERIES STUDY: PLAYERS MISUSE PAINKILLERS PAINKILLER USE IN TODAY'S NFL ABOUT THE PAINKILLERS STUDY ADDITIONAL RESOURCES