England's Professional Footballers' Association has expressed concern over sleeping pill dependencies, as whistleblowers warn problem-usage is still surging throughout the game.
Two years after a Telegraph Sport investigation first exposed the issue, Ryan Cresswell, who has now gone public with his struggles, says the crisis has hit football "at all levels".
While some, like Cresswell, become addicted using them to get to sleep, a craze has also caught on where players mix the pills with alcohol at parties.
Others, including several Premier League and international stars, are said to take the concoction in a bid to create a "euphoric high" which will not lead to a drugs ban.
Players and chief executives have contacted Cresswell, a former defender who came through the ranks at Sheffield United, with similar stories after he first revealed over the summer how he had hit rock bottom.
A current league manager has also told Telegraph Sport privately of his "massive concern" around players abusing tablets recreationally rather than to treat insomnia.
'Sleeping pills are not being used by players to sleep'
Telegraph Sport disclosed earlier this month how Tramadol, a powerful painkiller behind harrowing stories of addiction in football, is being banned by the World Anti-Doping Agency.
But there are no such plans for the so-called "Z drugs", which are often handed out by doctors to players so they can sleep after adrenaline-fuelled late matches.
As a result, the PFA and Cresswell are imploring on players showing signs of addiction to come forward confidentially to get help.
"I'm hearing stories of what players are doing with sleeping tablets and it's not to sleep," the 34-year-old said. "That needs to be addressed."
Cresswell, a Sheffield United academy product who went on to play for Bury, Rotherham and Northampton, suggests clubs could provide a deterrent by using urine sample testing to monitor levels.
Since going public last month to explain how "I would have been dead" unless he quit the pills, he said he has heard from players "at all levels" in recent weeks.
"I've had many phone calls from players and private messages," Cresswell tells Telegraph Sport. "As a player you're putting pressure on the doctor to give you more. He'll only give you a set amount which he deems healthy, but then when you're trying to get more, online or whatever then you can get them and that's the problem."
The retired central defender, who now manages non-league Sheffield FC, is divorced and has become a full-time railway worker as he attempts to rebuild his life. He has since offered his services to the PFA, saying he would be willing to go into clubs and explain how the pills turned his life upside down.
'Even in small doses, prescription medications can be habit forming'
Dr Michael Bennett, the player union's director of wellbeing, has now acknowledged there is an issue to tackle in the domestic game.
"Through the PFA's wellbeing provision, we regularly support players who have developed addictive behaviours or dependencies," he said. "This can include a reliance on medication such as painkillers and sleeping tablets. There are many reasons why a player may begin to use sleeping tablets.
"It is common for players to struggle to sleep after night games as they find that it often takes time, both mentally and physically, to 'come down'. Other common issues, such as frequent international travel, particularly across time zones, can severely disrupt players' sleep patterns. Players may also simply be struggling with sleep due to personal issues such as stress, and might be concerned that it is damaging their rest and recovery.
"Prescription medications need to be used properly. Even administered in small doses, they can still be habit-forming and problematic if an individual becomes reliant. If players are using sleeping tablets or any other prescription medication and are concerned that they may have developed a dependency, we encourage them to speak confidentially with the PFA. Help is available."
Addiction in the game is worse than two years ago, insider says
A warning from Sporting Chance two years ago that prescription sleeping pills could be fatal appears to have been largely ignored by players.
Telegraph Sport reported in May 2020 how one Premier League player was seeking professional help for addiction. Since then, concerns have been expressed over at least two other high-profile players in the game. "It's got worse, not better", said one insider.
Over the past decade, players have been caught on camera inhaling balloons allegedly containing nitrous oxide.
"Laughing gas" is given to dental patients as a painkiller, but is also used as a social drug because of the euphoria it can induce. Sleeping pills, while widely used for their original purpose, have become more prevalent as a party drug over the past three years.
Sleeping tablets are seen as a necessity by many footballers given the heavy use of caffeine pills before matches and heavy travel.
Rio Ferdinand, Phil Neville and Craig Bellamy are among players to describe how drugs such as Zopiclone are commonplace in the game to aid sleep.
Harry Shapiro, of DrugWise, which publishes evidence-based information on drugs, said it is no surprise players have found other uses for the drug.
"In particularly high pressure situations like professional sports, people are going to find various ways of kind of chilling out, winding down, forgetting whatever problems they've got," he said. "Maybe dealing with depression because of injuries. They're available on prescription from your doctor, but inevitably they're as common as muck on the internet."
Tales of top-level players mixing sleeping pills and alcohol for 'a buzz'
"I didn't have the courage to say to someone 'Look, this is what is happening to me'," Cresswell says. "This is what I feel like'. I was just in my own bubble. And looking back, I just think 'why didn't I just say to someone' But we've all got a degree in hindsight. I just hope that by saying this, players will not feel alone."
Cresswell has been stunned by how many people in the game share his problems with sleeping pills. "I've had phone calls from players and private messages," he says. "I'm not telling them what I think they should do. I'm saying, 'this is what I did, this is what I do, and this is working for me'. Now that might not necessarily work for you. But give it a go."
He has heard the tales of top-level footballers using sleeping tablets as a recreational party drug, mixing them with alcohol to get a "buzz".
The issue needs to be addressed, he says. "Whether that be me, or someone who has experience with that addiction to go and speak to these players, and say 'look, this is what has happened to me'. 'This is definitely the road of what will happen if you continue to do this'. We can't just carry on letting this go under the radar."
In almost all cases, footballers get the majority of their sleeping pills via club doctors or their GP. Cresswell says "the ball is in the PFA's court", but he would be keen to start visiting clubs to talk through his experiences.
"My life was unmanageable," he adds. "I couldn't provide for myself, for my family, in the state that I was in. But having lived in denial, I've now flipped the positive on it. I'm divorced now but my ex-wife and I speak and we've got a little girl who is my world. If that doesn't get you out of bed in the morning, nothing will."