Slipper told his coach and the Queensland Rugby Union what was happening at home. But the 28-year-old, beloved of coaches for his tireless work rate on the field and as understated off it as you might expect of a tight forward, did not tell anyone how hard he was finding it to cope.

As Thursday's bombshell made clear, he was falling apart at the seams.

"Speaking with James quite a lot over the course of the last week, his first expression and first emotion when he found out about the situation was relief," Rugby Union Players' Association boss Ross Xenos said on Thursday. "That's an indication of some of the demons that he has been battling over the course of the last little while."

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This case was the first use of Rugby Australia's four-year-old illicit drugs policy. Slipper first tested positive to cocaine in a random urine test carried out at the Reds' Ballymore headquarters. He was fined $27,500, a mandated five per cent of his salary, and put into a mandatory testing pool. Under the policy, only Slipper, RA's integrity officer, and the chief medical officers from the Reds and RA knew about the violation.

His second violation this month came after a random test carried out at his Brisbane home. The positive result came with a mandatory minimum two-month suspension and a second $27,500 fine, plus notification of the QRU and RA. Within hours of being notified, QRU boss Richard Barker met Slipper at a local cafe to size up the player's emotional state. During the disciplinary process convened to determine his sanction, Slipper's best explanation for why he did not stop using cocaine even as he knew he was subject to random testing at any time and any place, was that he was "out of control".

The stakes are high now. Slipper's statement on Thursday, in which he took full responsibility for his actions and stated he and his medical team were optimistic about a "speedy" recovery, was consistent with his resolute and no-nonsense character. The reality of his situation, however, is that if he transgresses a third time under the policy, the penalty is automatic contract termination and a two-year ban from the game in Australia.

How a player as "clean", well-regarded and outwardly together, came to this position in his career is frightening. And therein lies the warning for rugby and all elite sport, where pressure, perfection and profile combine in a lethal cocktail with the universal highs and lows of the human condition.

Slipper's case will be compared to the case of another Reds player, Karmichael Hunt. But the suicide of the recently retired Wallbies second rower Dan Vickerman 15 months ago, which floored the rugby community, needs to be brought to the table too.

There is no suggestion the cases are the same but Vickerman was also a top-level athlete who suffered in silence. Rugby will be guilty of naivety at best, negligence at worst, if it does not include him in the conversation about what it can do to find and help the people who either do not know they need it or are desperately incapable of asking for it.

"Even a player of James Slipper's stature, such a well-respected person within rugby, still did not feel confident to openly speak out about his issues," Xenos said. "As a sport that's a constant reminder that as much as we talk a lot about mental health, there is still so much more that we need to do."