Drug Dependency

Examination (DDE)
Learning Objectives:
At the end of the module, the participant should be
able to:
1. define Drug Dependency Examination (DDE),
identify its importance and how to do it.
2. provide an accurate assessment/diagnosis
and extent of drug use to suspected drug
dependents for proper referral to appropriate
agencies.
Learning Objectives:

3. identify the components of a DDE.

4. identify the steps in the rehabilitation process
of patients applying for voluntary and
compulsory confinement.
5. identify the challenges in DDE.
Outline of Presentation

• Drug Dependency Examination (DDE)

• Components of DDE
• Voluntary and Compulsory Rehabilitation
• Challenges in DDE
DRUG DEPENDENCY EXAMINATION

• DDE is conducted by DOH-Accredited

Physicians who has completed the training
program in the Diagnosis, Treatment and
Management of Drug Dependents.
DRUG DEPENDENCY EXAMINATION

• DDE is conducted on individuals who are

suspected to be drug users, to provide an
accurate assessment and diagnosis on the
extent of drug abuse, whether he/she is an
experimenter, occasional user, or a drug
dependent, for proper referral to agencies or
appropriate management.
DRUG DEPENDENCY EXAMINATION

• It is based on the evaluation if the patient can

attend outpatient rehabilitation program or
undergo treatment and rehabilitation.
• The recommendation issued by the physician
will be presented to the honorable court for
issuance of a court order.
DRUG DEPENDENCY EXAMINATION

• DDE includes procedures such as:

1. Intake interview
2. History taking
3. Determination of the criteria for drug
dependency (use of DSM or ICD)
4. Mental Status Examination
5. Physical examination
DRUG DEPENDENCY EXAMINATION

6. Neurological examination
7. Psychological evaluation
8. Social case study
9. Detection of dangerous drugs in body
specimens through laboratory procedures
Components of DDE
I. Identifying Data/General Data
◦ Demographic summary of the patient by name,
age, marital status, sex, occupation, language,
ethnic background and religion
◦ Can also include the place or situation in which
the current interview took place, source of
information, reliability and whether the current
disorder is the first episode/admission
Components of DDE
o
Should also indicate whether this is a voluntary
submission, compulsory submission, probation,
apprehended, workplace, referred by schools,
DSWD or other gov’t. agencies, referred by
someone else or brought by someone else.
Components of DDE
II. Chief Complaint
◦ Patient’s own words
◦ Collateral informants as source of information
Components of DDE
III. History of Present Illness:
◦ Comprehensive clinical picture of the events
leading up to the current moment in patient’s
life
◦ Onset
◦ Immediate precipitating events or triggers
◦ What were the behavioral changes?
◦ Why was the patient brought to the doctor at
this time?
Components of DDE
IV. History of Past Illness:
◦ Medical
◦ Psychiatric
◦ History of detoxification
◦ Confinement in treatment and rehabilitation
center
Components of DDE
V. Family History
VI. Drug/Alcohol History
◦ What were the substances of abuse
◦ Onset, duration, frequency, dosage/amount,
last intake
Basic Points in a Substance Abuse
History

 Confidentiality
 Drugs to be asked

about
 Age of first use
 Period of heaviest

lifetime use
 The past three weeks
Basic Points in a Substance Abuse
History

 Validity of Drug and

Alcohol Histories
 Presence of Tolerance
and Dependence
 Mental Status
Examination
(Psychiatric Interview)
Components of DDE
VII. Mental Status Examination
VIII. Physical/Neurological Examination
IX. Remarks and Recommendation
Steps for Rehabilitation (Voluntary
Submission Cases) Pursuant to R.A. 9165
A. Apply for voluntary confinement
STEP I B. Get a letter of 1st Indorsement To DDB Legal Division

Submit the letter of Indorsement &

Secure a Court Order for Drug To Regional Trial Court (RTC)
STEP 2
Dependency Examination

Submit the letter of Indorsement &

DOH-Accredited Physician
STEP 3 Secure a Court Order for Drug
Dependency Examination

Submit the result of drug dependency

STEP 4 examination to the Regional Trial Court
to secure a Court Order for confinement

STEP 5 Proceed to the Rehabilitation Center

Section 61: Compulsory Confinement of
a Drug Dependent who Refuses to Apply
under the Voluntary Submission Program

1. Petition to be filed by the Dangerous Drugs

Board to the Regional Trial Court
2. RTC conducts hearings and issues court order
for DDE by two (2) DDB-Accredited Physicians
3. DDE results submitted to the Court
4. Court orders treatment and rehabilitation
Patients for Drug Dependency
Examination

• Voluntary
1. Individuals come by themselves and are
willing to be rehabilitated
2. Persons who need to be brought in by
relatives, friends or neighbors
Patients for Drug Dependency
Examination

 Non-Voluntary
1. Court referrals – persons (w/ civil or criminal

cases) who need to be identified if they are

drug dependent or not
2. Probation and Parole Office referrals –
probationers and parolees who need to be
identified whether they are drug dependent or
not
Patients for Drug Dependency
Examination

 Non-Voluntary
1. Follow-up and After Care cases – those
clients undergoing mandatory 18-month
follow-up after discharge from Rehabilitation

Center
2. Work place – employees/workers who
tested positive for drugs and need to be
identified if they are drug dependents or not
Patients for Drug Dependency
Examination
 Non-Voluntary
1. School referrals – students who are
referred for committing infractions or are
caught in possession or using drugs in
campus/vicinity of the school to determine
whether they are drug dependent or not
2. Social Service referrals – vagrants and
street children caught inhaling volatile
substances and those clients charged with
domestic abuse
STEPS IN THE REHABILITATION PROCESS FOR VOLUNTARY SUBMISSION CASES
Suspected Drug User
Drug Test

Drug Abuse Program Coordinator assessment

Accredited DOH Physicians

Experimenter or Occasional User

DAP Coordinator / Outpatient Center

School
Drug Dependent

Dual Diagnosis Detoxification

Psychiatric Hospitals Drug Dependent

Treatment & Rehab.
Center GO or NGOs

After Care
Challenges in DDE
• The general public and the relatives of patients
expect immediate help.
◦ The facility for drug dependency exam, the
laboratory for drug testing, the Dangerous
Drugs Board, the Court and the Rehabilitation
Centers are not conveniently situated in one
locality.
◦ Some cases could not be resolved in one day.
Challenges in DDE
• The DOH-accredited physician needs to be
accurate in his diagnosis.
◦ Patient denies he is using drugs.
◦ There is no informant or petitioner.
◦ Informant is not living with and/or is not
knowledgeable on the patient’s activities.
Challenges in DDE

◦ Patient can not communicate effectively (mute,

deaf, or does not speak local dialect).
◦ Patient was put in safekeeping for several
days or weeks prior to examination.
◦ Patient is abusing rugby/solvents or alcohol
and cannot be routinely tested for lack of
update on availability of drug test for these
substances.
Challenges in DDE
• The DOH-accredited physician has to give the
appropriate and necessary recommendation
based on his findings
◦ Informant / relatives are not in agreement over
patient’s drug status
◦ Relatives insist on bringing their mentally ill or
misbehaving patient to a drug rehab center
Challenges in DDE
◦ There is dearth of social institutions wanting to
admit misbehaving patients who are not drug
dependents
◦ Mentally unstable, elderly, pregnant women
and patients suffering from various medical
conditions present risk when referred for
rehabilitation
Challenges in DDE
• The DOH-accredited physician has to examine
parole and probation cases
◦ Clients are sometimes not properly identified
◦ Probation client frequently denies drug use
and there is no informant
◦ A client, in almost all instances, is not drug
tested immediately after or during the time of
arrest so no previous drug testing report is
transmitted to the examining physician
Challenges in DDE
• For court cases referred to DDB, to whom do we
submit our reports to?
• Overlapping of functions of various government
agencies
• Difficulty in referral system for problematic
patients who do not need rehabilitation but
require other services
 SCREENING & REFERRAL PROCEDURES

Source of Referral
(Voluntary, Arrested,
Court/School/Workplace Referred)

Intake Interview

DRUG DEPENDENCY EVALUATION

Urine Drug Social Case

Testing Psychological
Study
Testing

RESULT OF DDE
(Referral for Intervention)

Outpatient
TRC Follow
(Drug Dependent) Up/Treatment
TRCs/Psychiatric Detoxification
Others (Alcohol/other (CSRU/Other
Hospital/Centers Centers)
(Back to the substance
(Dual Diagnosis) intoxicated)
Source of
Referral) RMC
DSWD, RTCs,
Application for Voluntary Confinement
Learning Objectives:
At the end of the module, the participant should be
able to:
1. define Drug Dependency Examination (DDE),
identify its importance and how to do it.
2. provide an accurate assessment/diagnosis
and extent of drug use to suspected drug
dependents for proper referral to appropriate
agencies.
Learning Objectives:

3. identify the components of a DDE.

4. identify the steps in the rehabilitation process
of patients applying for voluntary and
compulsory confinement.
5. identify the challenges in DDE.