Did Deceased Dentist Expose Patients to Infection?

The Arkansas health department's announcement that a dentist who died more than a year ago may have exposed his patients to "infectious material" has thrust his history of drug abuse into the national spotlight, but the state dentistry board says it's not clear the dentist did anything wrong.

The Arkansas Department of Health announced this week that it would contact the 100 patients Dr. William Jarrod Stewart treated with the intravenous painkiller meperidine -- known as Demoral -- between Nov. 20, 2011 and Feb. 20, 2012. Stewart committed suicide on Feb. 29, 2012 at age 40 shortly after he lost his job, according to his father.

"Anybody around him would tell you he was a great dentist," Stewart's father, Larry Stewart, told ABCNews.com. "He just had a problem with drugs. That's mainly what caused all this."

RELATED: Oklahoma Dentist Could Face Criminal Charges

Stewart had issues with substance abuse in the 1990s when he was living and practicing dentistry in Louisiana, and he eventually surrendered his dentistry license there, said Arkansas Board of Dentistry attorney Bill Trice. After completing a rehabilitation program in 2000, he asked for a dentistry license in Arkansas. It was granted on the condition that he complete a five-year program with daily drug testing.

Stewart was drug-free for the full five years, but he relapsed and had to complete the five-year program again, Trice said. In 2010, Stewart completed the program a second time. For the next two years, the dentistry board didn't hear about any problems.

ABC News

Dr. William Jarrod Stewart treated patients... View Full Size

Dentist's Patients Tested for HIV, Hepatitis Watch Video

LeAnn Rimes Sues Dentist Watch Video

Death and Greed at the Dentist Watch Video

Ocean Dental, which owned several clinics where Stewart worked, asked Stewart to take a drug test on Monday, Feb. 20, 2012 after he appeared to be impaired during Sunday communications with Ocean Dental employees. He was told he would be fired immediately if he refused, but he refused anyway, according to a statement from Ocean Dental.

The dental board did not know why Stewart was fired, Trice said.

Then, Stewart committed suicide by overdosing on drugs on Feb. 29, 2012, according to Pulaski County Coroner Gerone Hobbs.

Six months later, in August, the Drug Enforcement Agency got a complaint from a former employee of the dental clinic where Stewart worked, prompting the agency to visit the clinic, Trice said. Investigators found evidence that two vials were tampered with, but they didn't find evidence of any disease.

Trice, who has been a prosecutor on behalf of the dentistry board since the early 1980s, said he's not convinced Stewart contaminated any drugs.

"They've got all these isolated facts out there, but I'm not sure the dots connect," Trice said.

RELATED: Okla. Dentist's Former Assistant Gave Anesthesia, Didn't Know It Was Illegal

DEA spokesman William Bryant said two separate sources called to say the single doses of these drugs were compromised. The second call came in as late as last week, he said.

Stewart's former patients were advised to seek tests for blood borne diseases like HIV and hepatitis b, but Larry Stewart said his son was tested and the results were negative. Given the length of time between the death and the announcement, he said he felt his son's name was "truly smeared."

"We feel like we've been violated," Larry Stewart said. "These things would have already come to light if there had been any diseases, yet they took it upon themselves to put it out to the public nationwide 13 months after the fact."

The Arkansas Department of Health was notified eight days ago, but it needed the time to determine how best to inform patients and convey the low level of risk, according to state epidemiologist Dr. Dirk Haselow.

"We definitely believe that people needed to be notified," Haselow said. "No one else in those facilities had sedation privileges, therefore no one else had access to those medications."

Up to 12 percent of all physicians in the United States develop a substance abuse disorder, according to a 2008 study published in the British Medical Journal, BMJ.

The public health scare comes less than two weeks after an Oklahoma dentist was accused of exposing 7,000 of his patients to HIV, hepatitis B and hepatitis C.

Johns Hopkins scientists create Web-based tool to help patients decide on kidney transplantation

Johns Hopkins scientists have created a free, Web-based tool to help patients decide whether it's best to accept an immediately available, but less-than-ideal deceased donor kidney for transplant, or wait for a healthier one in the future.

Historically, the researchers say, it has been difficult, if not impossible, to accurately quantify the risk of accepting a deceased-donor kidney that may have been infected by hepatitis C, as compared to waiting what could be months or years for a better organ. There is a 5 to 15 percent chance of dying every year on the waiting list. Often, organs that may have been at risk of infection are thrown away and never transplanted.

In a new study described online in the American Journal of Transplantation, the Johns Hopkins researchers showed there are some types of patients for whom survival benefit outweighs the risks of accepting a possibly infected organ. They then developed a Web-based mathematical model to help predict which patients they would be. The easy-to-use website can be found at www.transplantmodels.com/ird.

"Because the supply of the healthiest donor organs is too small, patients need to consider all organ offers or risk dying while waiting for an organ. But this is a very hard decision, and many people turn down transplant offers that, in reality, would provide them significant benefit. Often they would have done much better taking the organ at hand than waiting for the next available one," says study leader Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine. "This is the most important decision of a transplant candidate's life, and we have developed a novel tool we believe can help patients make the best choice."

Before they are made available for transplant, kidneys and other organs from deceased donors are tested for infectious diseases such as HIV and hepatitis C. But even when the tests come back negative, there is still a chance that some kidneys could be infected, more commonly with hepatitis C, because of donor risks such as intravenous drug abuse, prostitution, imprisonment and other criteria established by the U.S. Centers for Disease Control and Prevention. Although the risk of transmission of hepatitis C is low for transplanted kidneys, more than 10 percent of deceased donors in 2011 met the CDC criteria for infectious risk.

To develop the model, Segev and his colleagues pooled data from dozens of published papers and national databases of hundreds of thousands of patients. When information was missing, they sought out expert opinion to fill in the holes. They considered how long patients had been on a waiting list, whether they had undergone previous transplants, their age and whether they had diabetes, among other factors. Finally, they developed a complex statistical model and computer program to take all the factors into account and present it in a user-friendly manner.

Obama Budget Includes $235M For Mental Health

President Obama is asking for $235 million as part of his new budget proposal to fund mental health initiatives. Of the funds, $130 million will be used to train teachers and others to identify signs of mental illness in students and provide them with access to treatment.

Secretary of Health and Human Services Kathleen Sebelius wrote in a blog on her agency's website Tuesday that the funds include $205 million to help identify mental health problems, improve access to mental health services and support safer school environments. The plan would affect at least 8,000 schools according to Sebelius. Another $30 million will go toward public health research on gun violence.

"We cannot ignore the fact that 60 percent of people with mental health conditions and nearly 90 percent of people with substance use disorders don't receive the care they need," Sebelius said in the post.

According to a January report the Obama administration planned to spend $50 million to fund Project AWARE (Advancing Wellness and Resilience in Education), which would train teachers to identify signs of mental illness or provide "Mental Health First Aid" and ensure that students have access to mental health care. According to the report, Project AWARE would reach 750,000 young people.

Charles Dharapak/AP Photo

President Barack Obama speaks about his... View Full Size

Mental Illness on the Rise Watch Video

Mental Woes On The Rise Watch Video

Arizona Infant's Cancer Case Baffles Doctors Watch Video

Another $50 million would go to training 5,000 people to become mental health experts at the master's level to help alleviate the shortage of mental health professionals. The funds would also support state-based strategies aimed at helping those between the ages of 16-25 get access to and navigate behavioral treatment programs.

Mental health experts say it is vital to treat mental illnesses as early as possible. According to the National Institute of Mental Health, half of all lifetime cases of mental illness can be diagnosed by age 14 and approximately three-quarters of these cases are diagnosed by age 24.

Dr. Paramjit Joshi, chair of Behavioral Health, Children's National Medical Center in Washington D.C., says there is on average eight years between a person showing signs of mental illness and getting diagnosed with a disease. She says if children and teens are diagnosed early, they are less likely to drop out of school or turn to substance abuse.

"Like other illnesses if you can catch this early, the benefits are monumental," said Joshi. "Children spend the majority of their day in the school setting. I think it will be wonderful for teachers to be better prepared and be aware what are signs and symptoms of these conditions early and refer them for appropriate services."

By centering the initiative in schools throughout the country, Joshi says it could also help make mental illness a less taboo topic.

"I think I also there's a lot of stigma attached to mental illness, if there is service provided in that school it puts a dent in that stigma," said Joshi. "It would be great if mental health is incorporated into overall health of the child."

Mel Riddile, associate director for the National Association of Secondary School Principals, says in order for these initiatives to work they need to be more than just short training sessions.

Riddile says it's important schools have relationships with parents and the local mental health care system so that teachers and school officials feel there is someone that can help them if they have concerns about a student.

"When people have nobody to talk to, they won't ask the question if they don't think they're going to get [help.]," said Riddile. "It's a matter of creating a network, where when issues come up they can ask a question."

Researcher awarded NIH grant to study drug-related health disparities in African-Americans

Your body's ability to effectively respond to stress may be an indicator of your vulnerability to use and abuse drugs.

A five-year, $2.5 million grant from the National Institute of Health (NIH) / National Institute of Drug Abuse (NIDA) will support research from the University of Houston College of Education to investigate mechanisms that influence drug-related health disparities in the African-American community.

Ezemenari M. Obasi, associate professor in counseling psychology and director of the Hwemudua Addictions and Health Disparities Lab (HAHDL) at UH, will lead research in Harris county and eight surrounding urban and rural counties. He says the development of drug use and abuse in the African-American community is often informed by research that rarely include African-Americans or their social and cultural experiences.

"It's a longitudinal study that will include 350 participants between the ages of 18 and 25," he said. "We'll be partnering with the community to learn how a person's social environment and related stressors can 'get-under-the-skin' and have a harmful impact on the body's regulatory system or its capacity to effectively cope with day-to-day stressors across time."

Those stressors, he says, could include exposure to violent crimes, experiences of discrimination, lack of green space, unemployment, substandard housing, substandard educational systems, pollution, high density of drug-retail outlets, and ability to pay bills and/or put food on the table.

A focal point of the research is measuring how the body reacts to environmental stressors. The body has a complex network between organs that control how we deal with stress, among other things, by regulating the production and elimination of stress-related hormones. However, chronic exposure to stressors may lead to "wear-and-tear" on this system and compromise the body's ability to effectively cope with stress. Those who have fallen into substance abuse may produce too little - or too much - of these stress-related hormones, what Obasi calls a "dysregulated human stress response."

"We are hypothesizing that people are finding ways of coping with stressors through other means as their natural human stress response begins to break down," he said. "While seemingly effective in the short-term, substance use may accelerate the breakdown and increase one's susceptibility to drug-related health disparities 20 or so years down the line."

Five cohorts (70 participants each) will be assessed and monitored for two years. While much of the research will be done in their communities and home, a great deal also will be conducted at his HAHDL.

Rutgers' Mike Rice Rage: Bad Behavior or a Disorder?

Throwing balls, kicking players, shouting gay slurs -- all of these outbursts caught on videotape of Rutgers basketball coach Mike Rice reveal the abusive nature of uncontrollable anger.

Rice was fired this week, and faculty and alumni have been in an uproar. But was his angry performance during a men's basketball team practice last year just bad boy behavior or something more diagnosable?

"There is a misconception that getting anger out helps you calm down, but ironically, it makes you more angry," said Camp Hill, Pa., psychologist Pauline Wallin, author of the 2004 book "Taming Your Inner Brat."

Watch more on this story on "20/20: Losing It!" Friday at 10 ET

"The angrier you get, it gets increasingly harder as you are pumping more adrenaline, and there is more energy to discharge. Yelling and screaming don't get you calmer, they rile you up."

The university's reputation is still stinging from the 2010 suicide of gay student Tyler Clemente, whose roommate had secretly videotaped the freshman having sex and was convicted of a hate crime..

Today, a group of 13 faculty and alumni demanded that university president Robert Barchi resign, because it took months for him to take action.

Barchi first viewed the video in November and sent Rice to anger management counseling. He fired the coach on April 3, when the video again resurfaced.

Kevin Rivoli/AP Photo

Former Rutgers University men's basketball... View Full Size

Rutgers University Coach Fired Watch Video

Fired Rutgers Coach 'Deeply Sorry' for Kicking Players Watch Video

Female Bounty Hunters Accused of Excessive Force Watch Video

Even New Jersey Gov. Chris Christie weighed in on Rice, applauding the firing in the New York Times: "The way these young men were treated by the head coach was completely unacceptable and violates the trust parents put in Rutgers University."

Experts say the most common form of aggressive anger is rage, which is a psychological and physiological response to a stressor event. A person can lose his or her capacity for rational thought. The capacity for rage often begins early in life and continues through adulthood.

A person in rage may also experience tunnel vision, muffled hearing, increased heart rate and hyperventilation. The large amounts of adrenaline and oxygen in the bloodstream may cause a person's extremities to shake.

Psychiatrists say the most extreme form of rage is intermittent explosive disorder, or IED. "It's somebody who really lacks control and is way over the top," said Wallin, who did not speculate on why Rice behaved as he did.

According to the Mayo Clinic, the disorder, which is listed in the DSM-V, involves repeated episodes of "impulsive, aggressive, violent behavior or angry verbal outbursts in which you react grossly out of proportion to the situation."

Recurrent, problematic, impulsive aggression affects 5 to 7 percent of the population, but many Americans do not seek treatment, according to a study published by the American Medical Association.

Research shows that chemical abnormalities are associated with this disorder. People with IED can suddenly explode without provocation.

Examples can include road rage, domestic abuse, throwing or breaking objects, or other temper tantrums. Those affected may attack others, cause bodily injury and property damage. They may also hurt themselves. Later, when they have calmed down, they can feel remorse, regret or shame. Effective treatments can include antidepressants and cognitive behavior therapy.

Wallin admits she is not an expert in IED, but she has witnessed plenty of anger, including physical fights, at sporting events like hockey.

"They are yelling at each other, sitting down and getting rough with each other and all excited with the adrenaline," she said. "The reason they have no control is they are really hyped up. Even the fans love to see the fights."

Experts caution that IED goes outside the bounds of normal anger and is considered an impulse disorder.

Study: Altering brain activity with laser light eliminates addictive behavior in rats

By stimulating one part of the brain with laser light, researchers at the National Institutes of Health (NIH) and the Ernest Gallo Clinic and Research Center at UC San Francisco (UCSF) have shown that they can wipe away addictive behavior in rats - or conversely turn non-addicted rats into compulsive cocaine seekers.

"When we turn on a laser light in the prelimbic region of the prefrontal cortex, the compulsive cocaine seeking is gone," said Antonello Bonci, MD, scientific director of the intramural research program at the NIH's National Institute of Drug Abuse (NIDA), where the work was done. Bonci is also an adjunct professor of neurology at UCSF and an adjunct professor at Johns Hopkins University.

Described this week in the journal Nature, the new study demonstrates the central role the prefrontal cortex plays in compulsive cocaine addiction. It also suggests a new therapy that could be tested immediately in humans, Bonci said.

Any new human therapy would not be based on using lasers, but would most likely rely on electromagnetic stimulation outside the scalp, in particular a technique called transcranial magnetic stimulation (TMS). Clinical trials are now being designed to test whether this approach works, Bonci added.

The High Cost of Cocaine Abuse

Cocaine abuse is a major public health problem in the United States today, and it places a heavy toll on society in terms of lost job productivity, lost earnings, cocaine-related crime, incarcerations, investigations, and treatment and prevention programs.

The human toll is even greater, with an estimated 1.4 million Americans addicted to the drug. It is frequently the cause of emergency room visits - 482,188 in 2008 alone - and it is a top cause of heart attacks and strokes for people under 35.

One of the hallmarks of cocaine addiction is compulsive drug taking - the loss of ability to refrain from taking the drug even if it's destroying one's life.

What makes the new work so promising, said Bonci, is that Billy Chen of NIDA, the lead author of the study, and his colleagues were working with an animal model that mimics this sort of compulsive cocaine addiction. The animals, like human addicts, are more likely to make bad decisions and take cocaine even when they are conditioned to expect self-harm associated with it.

Study shows relationship between cocaine-induced brain deficits in prefrontal cortex and cocaine-seeking

Could drug addiction treatment of the future be as simple as an on/off switch in the brain? A study in rats has found that stimulating a key part of the brain reduces compulsive cocaine-seeking and suggests the possibility of changing addictive behavior generally. The study, published in Nature, was conducted by scientists at the Intramural Research Program of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the University of California, San Francisco.

"This exciting study offers a new direction of research for the treatment of cocaine and possibly other addictions," said NIDA Director Dr. Nora D. Volkow. "We already knew, mainly from human brain imaging studies, that deficits in the prefrontal cortex are involved in drug addiction. Now that we have learned how fundamental these deficits are, we feel more confident than ever about the therapeutic promise of targeting that part of the brain."

Compulsive drug-taking, despite negative health and social consequences, has been the most difficult challenge in human drug addiction. NIDA researchers used an animal model of cocaine addiction, in which some rats exhibited addictive behavior by pushing levers to get cocaine even when followed by a mild electric shock to the foot. Other rats did not exhibit addictive responses.

The NIDA scientists compared nerve cell firing patterns in both groups of rats by examining cells from the prefrontal cortex. They determined that cocaine produced greater functional brain deficits in the addicted rats. Scientists then used optogenetic techniques on both groups of rats -- essentially shining a light onto modified cells to increase or lessen activity in that part of the brain. In the addicted rats, activating the brain cells (thereby removing the deficits) reduced cocaine-seeking. In the non-addicted rats, deactivating the brain cells (thereby creating the deficits) increased compulsive cocaine seeking.