NEW ORLEANS - When they're not talking about the Super Bowl this week, the Baltimore Ravens and San Francisco 49ers have been asked repeatedly to ponder their future - as in whether they will be mentally sharp in retirement after years of football.
"The scary thing right now is that you just don't know," Ravens center Matt Birk, a 15-year veteran, tells USA TODAY Sports. "There is just so much that is unknown."
Ray Lucas can give them a glimpse at what the future may hold.
The former NFL quarterback played seven NFL seasons and says he suffered 19 concussions. Now 40, he says he has symptoms that hint at degenerative brain disease.
It is a concern shared by some veteran players and those already retired. The death of Junior Seau, who shot himself in the chest in May, has only heightened their worries, especially after researchers from the National Institutes of Health announced this month that their examination of the former all-pro linebacker's brain revealed what many suspected. Seau suffered from chronic traumatic encephalopathy (CTE), a brain disease that has been linked to the type of repeated head trauma that can occur in football.
"If Junior could have gotten some help, maybe he would still be around," says Sean Salisbury, the former quarterback (1987-96) and former ESPN analyst. Lucas and Salisbury are among a group retired players who are taking a proactive role in dealing with possible degenerative brain disease.
They have joined a program in in Paterson, N.J., called Pain Alternatives, Solutions and Treatment (P.A.S.T.), which coordinates pro bono medical care and peer-group therapy. Lucas, Salisbury, former wide receiver Charlie Brown, former guard Brent Boyd and former running back Christian Okoye are among those who participate in monthly meetings.
"I think we've saved a couple of guys who were contemplating suicide," says Lucas, who is now a peer-group leader.
Overcoming a 'tough-guy menality'
Since retiring from football, Lucas has worked as a broadcaster in the New York market and undergone three neck surgeries and five knee operations. He has battled depression and addiction to pain-killing medication. At one point, Lucas says it took him several hours to get out of bed each day and he estimated that he swallowed 800 pills per month.
In 2010, the married father of three daughters says he contemplated driving his truck off the George Washington Bridge.
"I was a drain on my family, thinking, 'They're better off without me,'" he says. "That was a vicious cycle I was on."
Lucas says he believes his life was saved by a phone call to Jennifer Smith, who runs the player program at P.A.S.T., which was founded by William Focazio. Lucas underwent several surgeries, went through drug rehab and is now a participant in a concussion program that includes a holistic approach to healing.
Patients are prescribed a nutritional diet and hormone therapy intended to address symptoms associated with CTE. Focazio says key objectives are to reduce inflammation in the brain and eliminate toxins that he believes can predispose someone to CTE.
Salisbury says the peer-group sessions have been a big help to him as he tries to put his life back together.
"This is like Alcoholics Anonymous for a whole bunch of other issues," Salisbury says. "There's no shame in it. You think you've got problems, then you look at the guy next to you and he's worse off than you are. He'll say something like, 'Three weeks ago, I was ready to die.'"
Salisbury, 49 and divorced, says he couldn't estimate how many concussions he endured during his playing career but a significant portion were probably undocumented. He has also had multiple neck, back and shoulder surgeries.
He left his job with ESPN after a so-called "sexting" scandal, only to get fired from a Dallas radio station. He has been involved with P.A.S.T. since 2010 , and credits the program for helping him manage anger issues and depression.
"I was scared," he says. "We grow up with this tough-guy mentality. We're so used to dealing with pain. You think, 'I can fix this. I can make myself better.' While it goes on, though, there's no end point."
Salisbury, in town for the Super Bowl, says that Seau's death was one in a series of events that scared him straight. He considered Seau a close friend.
"Hopefully, they can find a cure for this, to help slow down this disease," Salisbury says.
A looming threat
There are many questions and much debate on the CTE issue, though experts generally agree the disease stems from trauma that shakes the brain.
"It has affected college kids, high school kids, guys in their 30s, 40s, 50s and 60s. Guys that played a long time, guys that didn't play a long time," Birk says. "There's like no blueprint, where they can say this is why you're at a higher risk."
Concussions represent an obvious risk, but researchers also point to relatively low-impact collisions as a possible trigger for developing CTE, which to this point has not been diagnosed until death.
Birk, 36, says he has minor memory lapses and wonders if he's at risk, given horror stories linked to post-concussion symptoms.
"It's like, 'Oh, my gosh, I can't remember where I put my keys. I can't remember what I opened the refrigerator for,'" says the father of six, citing three concussions since high school. "You try not to overreact. That's part of life. Anybody who's a parent knows. A lot of times, your brain is doing a lot of different things and you're sleep-deprived. I talk to other people my age who are not football players, and they say, 'It happens to me, too.' But you never know."
The issue is only growing. More than 4,000 former players are suing the NFL, alleging the league didn't do enough to reveal the dangers of head injuries. A broader spotlight was cast this week when President Obama said during an interview with The New Republic that if he had a son, he isn't sure that he would want him to play football.
As a result, players preparing for Super Bowl XLVII are virtually forced to contemplate how the risks, research and tragedies hit home.
"I'd be lying if I didn't say that sometimes it scares me," says Ravens safety Bernard Pollard, regarded as one of the NFL's hardest hitters
Despite a climate in the NFL for increased safety, Pollard - whose helmet-to-helmet blow knocked Patriots running back Stevan Ridley out of the AFC title game with a concussion - declares that he won't alter his style. He has grumbled that more rules changes will significantly diminish the game.
The risks to his own long-term health?
"I know what I signed up for," he said. "We play a violent sport. You can't sugarcoat it."
Pollard's fellow safety, Ed Reed, contended that Seau willingly signed up for the risk of developing the disease linked to his death.
"Junior gave everything he had to football," Reed said during Tuesday's media day session. "I'm sure he's looking down and has no regrets."
It is not uncommon to find such a matter-of-fact tone from active players, many of whom have seemingly been conditioned to downplay risks .
"Everybody knows the factors," said 49ers defensive tackle Justin Smith. "I don't think anybody's really shocked that you might have damage done to you. It's like any job. There's going to be risk. Ours is physical, and down the road. When you see older players, with all the brain stuff that's been brought up, it's more in the front of everybody's mind. The main thing is you haven't seen anybody quit."
Perhaps that's because there are so many questions lacking definitive answers. When does CTE begin? Is it reversible? Can individual risk be identified through gene testing? Is there a relationship between CTE and the use of pain-killing medication?
"I think it's entirely possible that if you cannot reverse it, you can wall it off and stop it in its tracks and it never gets worse," says Ann McKee, director at neuropathology at the Department of Veterans Affairs in Bedford, Mass.
McKee, who has conducted brain research for more than 26 years, began studying the post-mortem brains of former football players in 2008. She confirms CTE with a microscope, identifying levels of tau protein in the brain tissue.
"There seems to be a point in this disease where you go over a critical threshold," McKee says. "You build up enough of this abnormal protein, it affects enough cells, that if you never do anything adverse to your brain in your life, it's going to continue to get worse."
A potential breakthrough was revealed this month by Gary Small and Julian Bailes, who collaborated on a study of five living former football players that detected the tau protein associated with CTE.
The subjects - the identity was revealed of one, Wayne Clark, 65, a former backup quarterback - were injected with a compound developed by Small and others at UCLA for research into Alzheimer's disease, known as FDDNP, that attaches itself to tau protein and can be detected during a PET (positive emission tomography) scan.
Said Bailes, "The hope would be if you could identify them while they are in the early states, they could be treated."
Birk wonders if Seau's decision to shoot himself in the chest - the same way former Chicago Bears safety Dave Duerson committed suicide in 2011 - was a final effort to help others.
"They knew something was wrong with them," Birk says. "Their depression was so great that they wanted to preserve their brain for study. That's a scary thing. When you think of suicide, you don't think someone would think of it that clearly or that far ahead."
Jarrett Bell, USA TODAY Sports