How Brain Trauma Can Cause Addiction

By Adam K. Raymond 06/13/12

Lethal drug addiction is disturbingly common among pro athletes, like boxer Johnny Tapia and a long roster of NFL players, who suffer head trauma and chronic pain. Sadly, the more we know, the less anyone seems to care.

Tapia throws a left hook

The last time Johnny Tapia saw his mother she was chained to the back of a pickup truck screaming for help. He was screaming too. Only eight years old at the time, Tapia remembers pounding on a window inside his grandparent’s house as two men shrouded in darkness drove away to rape and murder his mother. With 26 plunges of a screwdriver, those men took Virginia Tapia’s life and inadvertently created one of the toughest boxers of the past 20 years. A beloved five-time champion with a career 59-5-2 record, Tapia began every fight by looking across the ring and seeing the faceless killers who took his mother.

“All the fury and hate. It had to go somewhere. My opponent was the man who killed my mother. And I wanted to kill him,” Tapia wrote in his 2006 autobiography, Mi Vida Loca.

After a career that spanned 23 years, Tapia died on May 27. He was 45 years old and had lived a life rife with physical and emotional trauma. A year after his mother’s murder, Tapia’s uncles began forcing him into brawls with older boys. He would later battle depression, addiction and bipolar disorder. Before dying in May, he’d been clinically dead at least four times before, the result of multiple drug overdoses. By the time Tapia died, his brain was like his body: battered, sore, flaunting the scars of a life hard-lived. But for all the observable damage Tapia endured, there was, in all likelihood, one thing that remained hidden—brain damage.  

Symptoms of CTE include confusion, headaches, impaired judgment and a lack of impulse control, which often manifests as an inability to resist bad things that feel good—namely, drugs.

Once referred to as dementia pugilistica, the form of brain damage most commonly found in boxers is now called chronic traumatic encephalopathy (CTE). It’s caused, quite simply, by accumulated blows to the head, and over the course of the past decade, it's been revised as something that isn't just a boxer's problem. CTE has been discovered in other athletes, especially football and hockey players, as well as countless combat veterans who suffered the concussive blow of roadside bombs. Symptoms include disorientation, confusion, headaches, impaired judgment and a lack of impulse control, which often manifests itself as an inability to resist bad things that feel good—namely, drugs.

“Many [athletes with CTE] have developed drug and alcohol abuse issues,” says Chris Nowinski. A former Harvard football player and WWE wrestler, Nowinski founded the Sports Legacy Institute in 2007 and teamed with Boston University’s Center for the Study of Traumatic Encephalopathy to study issues of brain trauma in sports. Among the CTSE’s findings is that repeated blows to the head cause degeneration of the frontal lobe, the part of the brain responsible for impulse control. A loss of impulse control can in turn lead someone who wouldn’t otherwise touch legal or illegal drugs down a dark path of addiction. Even if an athlete avoids the severity of CTE, a career full of concussions can cause recurring headaches, which can lead opiate abuse. Sometimes these paths to addiction exist independently. Other times they work together. “A lot of [athletes with CTE] were actually self-medicating through headaches, didn't have any impulse control [and] would get addicted to things,” Nowinski says.

This isn’t to say Tapia’s decades of addiction were caused by the damage almost surely done to his brain. His alcohol, cocaine and opiate abuse were likely the result of many risk factors. Still, after 66 professional bouts, it’s not difficult to imagine the thousands of hits Tabia took to the head contributing to his addictive personality. Nor is it difficult to see the connection between CTE and drug addiction in other athletes. Hockey players (Derek Boogaard, Bob Probert), football players (Tom McHale, Mike Webster) and pro wrestlers (Test, Chris Benoit) have all suffered addiction before dying young—through overdose or suicide—and receiving a posthumous CTE diagnosis. The disease can only be found by slicing open the brain, so we can only grimly speculate on the role blows to the head play in the drug problems of athletes like Oscar de la Hoya, Mike Tyson and the seven percent of retired NFL players who misuse opiates. But as we learn more about the problems caused by head trauma, the evidence against it is piling up. 

Diagnoses of CTE go back to the 1920s, when the chief medical examiner of Essex County in Newark, New Jersey, first wrote about “punch drunk syndrome.” In 1973, an English neuropathologist sliced up the brains of 15 dead boxers and saw what the disease looked like for the first time. But it wasn’t until CTE was found in the brains of football players in 2002 that it became much more than just a boxer’s disease. Since then CTE, which causes degeneration of brain tissue and the build-up of the harmful tau protein, has been found in more than 20 dead athletes along with combat veterans of the wars in Iraq and Afghanistan. 

CTE is caused by multiple concussions, smaller subconcussive hits or, in the case of most vets, one intense blast. And the physical changes it causes in the brain may appear either months or decades after the trauma. When the changes do show up though, so too will the unmistakable symptoms, which almost always include impaired judgment and difficulty controlling impulses. 

Tom McHale used to be able to control his impulses just fine. His wife Lisa remembers when she met him at Cornell. He was 23 and on his way to the NFL. She was 19 and “instantaneously crazy about him.” They married four years later and Tom went on to play nine seasons for the Buccaneers, Eagles and Dolphins. After he retired Tom, started a restaurant in Tampa, got involved in real estate and gradually, Lisa writes, started “slipping away from us.” 

It began with depression and chronic pain that grew so bad he was unable to work on his feet. Before long he admitted to Lisa that he was dependant on painkillers to manage the aches in his joints. To counter the sluggishness brought on by the painkillers Tom picked up a cocaine habit. “The man that I so admired had become like a shell of his former self, almost as if the spark was slowly being extinguished,” Lisa wrote

On May 25, 2008, Tom died of an accidental overdose. Less than a week prior Lisa kicked him out of the house for using cocaine while the kids were home. A once-responsible father making decisions like that is just one reason why Tom’s CTE diagnosis would not come as a surprise.

Tom McHale’s story represents the extremes of the issue. He both developed the most serious form of brain damage found in athletes and experienced one of the most serious symptoms of that damage. Many other trauma-suffering athletes will never get a CTE diagnosis, nor will they dabble in cocaine. According to an ESPN-commissioned study released last year, they’ll just abuse the drugs that allowed them to function in their playing days: opiates.

ESPN’s survey of 644 former NFL players found that 52 percent of them used painkillers in their playing days and 71 percent of that group misused the drugs. Fifteen percent of those who misused painkillers continued to misuse them into retirement. And 98 percent of those misusers said they suffered undiagnosed concussions while in the league. “We were shocked to learn that [current prescription painkiller] misuse is really associated with undiagnosed concussions," said the study’s director Linda Cottler, a professor of epidemiology in Washington University's Department of Psychiatry.

The same phenomenon exists on the ice, where hockey players get dinged up just as often as their gridiron pounding compatriots. Derek Boogaard, a beloved NHL enforcer whose primary role was to kick the crap out of opponents, became reliant on painkillers to cope with the lingering effects of broken bones, hits to the head and a back injury. Over time he added Ambien and alcohol to his addictions. Finally, in May 2011 the 28-year-old died in a Minneapolis hotel room after mixing pills with alcohol. His brain would be sent to the Boston University CSTE where doctors found CTE. 

Ted Johnson is still alive, so he doesn’t know if he has CTE. However, given the 30 or so concussions he suffered over his NFL career, he wouldn’t be surprised to learn he does. What Johnson knows for certain is that his brain doesn’t work like it used to. In 2007 the then-34-year-old’s neurologist sad the longtime Patriot was “show[ing] the minor cognitive impairment that is characteristic of early Alzheimer's disease.”

In his playing days Johnson was a notoriously hard hitting linebacker with a head the size of a three-year-old. As he’d learn, large doesn’t mean indestructible. In a four-day span during the summer of 2002 Johnson suffered two concussions, one in a pre-season game and the other in practice. Throughout the subsequent season he felt listless and cloudy. The effects lingered and in 2004 he received his first prescription for Adderall to help focus. It worked and in 2005, his first and only season while taking the amphetamine, Johnson had a career year. But in the offseason the thought of that warm, gooey haze that so often accompanies a hard tackle made him physically sick. He retired but things got worse. 

Johnson began to relay on Adderall more after leaving football. Off it he was tired and dizzy. On it he could function. Soon Johnson was visiting five doctors, telling each a different story that ended with him describing ADHD symptoms. “I became a pretty effective liar,” Johnson told 5280 magazine. “I just had to remember what story I told to what doctor; who was giving me 50 milligrams, who was giving me 75. As long as I kept the stories straight....”

Johnson went public with his addiction in 2007, a few months after the suicide of hard-hitting Eagles safety Andre Waters, who was diagnosed with CTE. “Every day there is a new study linking concussions to depression, as well as early onset of Alzheimer's disease,” Johnson told the Boston Globe. “It doesn't have to happen. It shouldn't happen. I don't want anyone to end up like me.”

There are already many others like Johnson. Some of them make up a group of 2000 players who’ve joined together to sue the NFL. They’re alleging that the league failed to act on knowledge of long-term neurological risks associated with football and willfully withheld information from players about the risks posed by concussions. The mega-suit combines more than 80 pending lawsuits against the NFL and asks the league to take responsibility for the care of players afflicted with neurological disorders. 

Of course, it’s important to note that thousands of people have played competitive contact sports without experiencing neurological issues. Among the unlucky who have, only a fraction developed a drug problem. And even within the group of former athletes who experienced concussions and addiction, other risk factors could have contributed to their drug dependence. Johnny Tapia, for example, grew up poor, lived with emotional trauma and was bipolar. Derek Boogaard coped with depression and countless bodily injuries. Ted Johnson and Tom McHale turned their joints to dust on the football field.

But if we’re willing to allow that those factors contributed to their addictions, shouldn't we also consider the brain-bouncing hits each took as his frontal lobe was reduced to an inferior version of its former self? Absolutely, because head trauma doesn’t have to cause addiction to help it on its way. 


Adam K. Raymond is a frequent contributor to The Fix. He also writes for The Daily, Vulture and He lives in Indiana. But not for long.


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Adam K. Raymond covers politics and sports for New York Magazine. Visit Adam's website and follow him on Twitter and LinkedIn.