No alarm sounds as Neil Breen climbs out of bed at 4:30 a.m. He set his alarm for six, but his body clock woke him up earlier, as it has nearly every day for the last 11 months.

As soon as the sun comes up, he heads outside and laces up a pair of rollerblades for a three-mile fartlek sprint around a loop by his house in Florida (he’s since moved to Nebraska). That’s followed by a hard 40-minute punching bag session and then weight training on alternating days.

It’s a drastic contrast from the first time The Chronicle spoke to Breen nearly two years ago. The former Quinnipiac men’s hockey bruiser is almost 100 pounds lighter than he was then, and more significantly, has shed much of the crushing weight that years of brain-rattling head injuries had burdened him with.

Traumatic brain injuries, or “TBIs,” are caused by repeated violent blows to the head, and are common in collision sports such as ice hockey. Such injuries have proven to serve as precursors to chronic traumatic encephalopathy, or “CTE,” a progressive and fatal brain disease that can only be diagnosed after death.

“(It’s) night and day,” Neil said. “I was a mess, a big time mess. I would just lose track of what I was thinking and saying … I would say drastic improvement, and if you talk to any of my family members, they would say the same thing.”

And they did.

“He’s done really well,” Heather Breen, Neil’s wife, said. “Do I think he’s cured? No, I don’t really think there is a cure. But have I seen a huge difference? Absolutely.”

After years of mounting symptoms that almost tore them apart, the Breen family: Neil, Heather and their two children, is stronger than ever, as evidenced by Heather’s latest tattoos, of bees.

“We’re the killer bees,” Heather said. “Because our last name is Breen. Together we’re united, or whatever.”

Neil has his own tattoos, all of which are equally meaningful, except for one of the Red Hot Chili Peppers logo, which Heather calls “horrendous.” She also wishes he’d clean up around the kitchen more. But those shortcomings are nothing compared to what the pair dealt with before Neil embarked on his current healing path.

Angry outbursts were common for him. Drinking exacerbated the problem. The tension rose and rose, culminating in an ill-fated move from Connecticut to Florida.

“There’s four of us and our dog and he’s pulling this huge 30,000-pound (trailer) and he was just screaming and freaking out,” Heather said. “I thought it was going to be the end of us. Like not divorce, I thought we were just going to die.”

But today there exists a much more mellow Neil. One who meditates when he wakes up in the morning and embraces conversations with his children about mental health.

“I’ve made a lot of realizations and taken a lot of steps to improve my health,” Neil said. “I was a miserable shell of my former self. And now I feel like I’m back, but there’s still a lot of unanswered questions.”

The science of recovery

In his recovery, Neil took it upon himself to find the solutions that he had too long sought in medications.

“I was taking every medication under the sun to treat the symptoms that come along with CTE,” Neil said. “Depression, anxiety, agoraphobia, all these things I was experiencing and I was just getting prescribed drug after drug and none of them worked.”

Seeking alternatives to clear the fog and get his life back, he tried a one-time controlled use of the psychedelic drug ketamine.

“There was other stuff like shrooms and Ayahuasca. I’m not doing that crazy shit,” Neil said. “Ketamine has at least been out on the market, it has a little bit more proven science behind it, so I went for it, and it worked.”

Ketamine is a non-competitive N-methyl-D-aspartate glutamate receptor (NMDAR) antagonist, and considered a psychedelic under the broad definition of the term. Used medically as a form of anesthesia for decades, the FDA approved the use of ketamine as an antidepressant in 2019.

Research in recent years suggests that ketamine promotes neurogenesis, cell proliferation, synaptogenesis and an increase in white matter in the brain – all of which aid in the regrowth of synaptic connections that have been severed as a result of unrelenting stress linked to depression and PTSD, according to John Krystal, professor of translational research, psychiatry, neuroscience and psychology at Yale.

Krystal co-authored a study in June 2023 that reported beneficial neural changes in patients suffering from PTSD following a single infusion of ketamine. He wrote in an Aug. 7 email to The Chronicle that the lack of research on the drug as a treatment with those suffering from conditions like Neil’s make it difficult to conclusively determine its efficacy.

“It is possible, but there has been very little study of ketamine effectiveness in TBI patients,” Krystal wrote. “An intriguing idea is that the neurotrophic (“nerve growth”) consequences of ketamine treatment might be helpful for TBI.”

Neil used the telehealth service Mindbloom to administer the treatment at home. He recalls seeing a strong female warrior figure lead him through the experience.

“It’s going to sound crazy, but some weird shit happened to me when I was tripping,” Neil said. “I couldn’t really put it into words, but they just sort of showed me which way to walk and there were some symbols in there, stuff that I had to break down with a therapist afterwards.”

Neil and his therapist concluded that the warrior represented the “warrior lifestyle” he lived both as a hockey player and fighter, and that he could harness that to help others along the same path.

“I think the drug took me to places that I’d never been before subconsciously,” Neil said. “And then the teaching and the work you do around it, like to learn how to meditate and stuff, just takes it even further.

“I learned how to control some of the behaviors I was experiencing and address setting intentions. Things you’ve heard your whole life are good to do … those are actually things that became lifesavers for me.”

 He began to simplify. Working out and training became a big part of his life again. Fasting made him feel strong and the switch to a carnivore keto diet heightened those feelings.

“I only eat animal products because I feel amazing,” Neil said. “I feel like I’m 20 again.”

But some question the sustainability of such a diet.

“Having a diet that is that strict, there are potential repercussions,” said Dana White, Quinnipiac sports dietitian and associate clinical professor of athletic training and sports medicine. “Carbohydrates are your primary source of energy. Your brain only runs on glucose … If no glucose is coming in, then it needs to be converted to something else and that’s not super efficient, just in terms of metabolism.”

More than a one-sport issue

Neil may feel 20, but in reality, he’s a 45-year-old who can’t be clinically diagnosed with CTE until after he dies. It’s one of the many things with the condition that makes it so hard to pinpoint.

“He’s done a lot better. It’s still hard. People don’t believe him, they think it’s an excuse,” Heather said. “If you’re not diagnosed as it because you can’t be diagnosed as it until you’re gone, then they think it’s just something you’re saying. And then as a spouse, you’re like both sides. You’re supportive, but also like, ‘Okay, are they pushing it a little,’ and then you feel guilty that you would ever leave someone that would be in this situation.”

The lasting impact of head injuries is not limited to former hockey players like Neil. Other athletes — predominantly football players — have gone through their own battles with CTE diagnosis. While he’s a lucky one, former NFL defensive end and Super Bowl champion Zach Moore knows how dangerous these injuries can be.

“Documented concussions, I definitely had several in college and in the league,” Moore said. “I’ve had a plethora of head injuries … I’ve read that if you’ve played football for an extended period of time, there’s a 99% chance that you’ll have CTE upon death.”

It sounds crazy, but he’s right. According to a 2017 Journal of the American Medical Association study, 99% of donated brains from former NFL players were diagnosed with CTE. The longer athletes played football, the worse the brain damage was.

Moore, who’s an International Sports Science Association certified personal trainer and licensed nutritionist, played five seasons in the NFL. Throughout his career — including stops in six different cities — he felt the collective weight that professional athletes feel, physically and mentally.

“Back when I was playing, it wasn’t really talked about,” Moore said. “We’re taught to be super aggressive, violent dudes … a lot of those spill into real life. It all correlates with our mental health.”

Moore doesn’t know Neil. He didn’t know his story. Yet, as athletes in a physical game, the former NFL draft pick felt for the former hockey star.

“It doesn’t matter how much money you make or what status your life is in, you’re not immune to what life can throw at you,” Moore said. “Definitely love yourself, take care of yourself and don’t be afraid to ask for help.”

There’s somewhat of a collective bond formed between athletes in high-contact sports. It’s what drew Breen to former USA Olympic bobsledder William Person, who he reached out to after reading an article in The New York Times about Person’s lawsuit against USA Bobsled for its alleged nondisclosure of head injury risk in the sport.

“William saved my life,” Neil said. “I’m going to the bank, and I couldn’t get out of the car to go in and I’d call William and be like, ‘Dude, I can’t get out of the car, has this ever happened to you?’ And he’d be like, ‘Yeah, dude it happens all the time, it’s this social anxiety thing.’ So I’m just sitting in there and he’s talking me off the ledge just to get me to go into the bank and get some cash.”

Neil has not fully overcome his symptoms, and likely never will. Both he and Heather acknowledge the incurable nature of traumatic brain injuries. But he has turned a corner in his recovery, and wants to help others do the same.

“I think it’s important that people know that CTE or suspected CTE doesn’t have to be like this crazy, terminal thing,” Neil said. “If you do the right things, eat right, exercise, learn how to meditate … you’re going to have a great life, and you can put a lot of side effects to the wayside.

“I’m super stoked that I played the sport, and I always will be.”

Where hockey is concerned, Neil doesn’t want to tear down or radically change the sport. And he certainly doesn’t want people to think that he blames his alma mater for his ailments. His love for Quinnipiac remains strong. The national championship trophy is front and center in his LinkedIn Banner.

“I almost think I needed to cycle back and make sure that people knew I wasn’t trying to bring down the program or bring down hockey, I guess I was just looking for ways to get help,” Neil said. “I even talked to (head coach) Rand (Pecknold), we had a good cry. Well I did, I don’t think he cried.

“Super proud of him and what he’s accomplished. Nothing I’ve said I hope ever hurts him. He’s a big influence and I’m happy the boys did it and I’m so proud to be a Bobcat.”

But that doesn’t mean Neil doesn’t want the game to progress. He preaches smarter hitting strategies to his players.

“I tell guys, the best way to hit effectively is to separate the man from the puck, not to blow him up,” Neil said. “If you can’t make contact with a guy by putting stick on puck, hands on hands, body on body, if you can’t do that with control, you shouldn’t really be hitting. You’re putting yourself at risk.”

After spending much of his adult life as a coach in nearly every junior league in the U.S., there are aspects of the culture that irk him – and the new Neil has no problem saying as much.

“There are owners out there that don’t care, they just want you to sign the kid and take the money, and I just can’t do that,” Neil said. “And when that happens, when I’m put in a position to make that choice or that decision, it’s fight or flight. It’s like, ‘if you make me do that, I’m out of here.’”

That idea of putting the individual second is why Neil says “hockey guys don’t tell the truth,” a sentiment amplified as the game’s biggest voices undermine the struggle of countless athletes like him by preaching a sermon of denial again and again in regard to the dangers of the sport.

“(Neil) did his thing for the Lancers and Quinnipiac and all the other people.” Heather said. “And now if you bring it up, it’s like ‘How dare you even say that CTE word around hockey that gave you this wonderful life,’ … It’s not right.”

Dozens of former hockey players have been posthumously diagnosed with CTE, including NHL legends Stan Mikita, Henri Richard and Bob Probert. A 2022 Boston University preliminary study found that each additional year of playing the sport may increase the risk of CTE by 23%.

Hockey’s physical nature cannot simply be removed from the game. It’s too interwoven in its fabric. But what Neil and many others are seeking is for the sport’s leaders to accept its consequences and adapt in response, promoting a smarter game and providing resources to prevent more lives from being derailed by the long-term impacts of head trauma.

The spiral that trauma sent Neil down pitted him against the game itself in his last interview with The Chronicle — a mental war against the sport that shaped a lot of who he is, the good and the bad. Today, he sings a different tone, adamant in what hockey has done for him … for the most part.

“I think my mindset back then was if I never played hockey, I would have never been feeling this way,” Neil said. “But I’m in a place now where I’m super stoked that I played the sport, and I always will be. But there will always be times too where I’m like ‘Damn, why didn’t I choose basket weaving.’”