Last updated 17 June 2011

AUTOS (Autonomy over Smoking Checklist) (adolescents & adults) AUTOS flier.pdf


NOTE: For smokers switching to e-cigarettes, “cigarette” in the questions below refers only to tobacco cigarettes.


Today’s date………. If has quit smoking, or switched to e-cigarettes, Date last smoked…..

Time from last cigarette to wanting, craving or needing another cigarette……. Hours, …. Days (=latency)*

Time to first cigarette after waking ………. Number of cigarettes per day……………….


Withdrawal Symptoms

(put a in the column that best describes me)

Not at all =0

A little =1

Pretty well = 2

Very well = 3


When I go too long without a cigarette I get impatient






When I go too long without a cigarette I get strong urges that are hard to get rid of






When I go too long without a cigarette I lose my temper more easily






When I go too long without a cigarette I get nervous or anxious






Psychological Dependence

Not at all =0

A little =1

Pretty well = 2

Very well = 3


I rely on smoking to focus my attention






I rely on smoking to take my mind off being bored






I rely on smoking to deal with stress






I would go crazy if I couldn’t smoke






Cue-Induced Craving

Not at all =0

A little =1

Pretty well = 2

Very well = 3


When I feel stressed I want a cigarette






When I see other people smoking I want a cigarette






When I smell cigarette smoke I want a cigarette






After eating I want a cigarette






Total AUTOS endorsements (score 1 to 12)

For these, score each in the 1, 2 or 3 right hand columns and add up to obtain the symptom intensity score (Maximum score 36 =3 x 12)

Don’t count ticks in this column.

Count the number of ticks in the above three columns = AUTOS endorsements (Range 1-12) Sum of symptom intensity scores (max 36) divided by AUTOS endorsements = Average symptom intensity (Minimum =0. Maximum =3).

The mean number of items endorsed in the earlier version (maximum 15) by adolescents were: for Never smoked <0.1; one puff, 0.2; a few cigarettes, 1.5; less than daily, 5.5; daily smokers 11.3 items.

Higher AUTOS scores are associated with a young age of starting to smoke, lifetime consumption, cigarettes per day, smoking frequency, and history of failed cessation. It applies to non-daily smokers, daily smokers, adolescents and adults at any stage in their smoking experience.

After quitting, AUTOS can chart regained autonomy, but some never regain this fully.

Autonomy over tobacco is lost when quitting requires an effort or involves discomfort. Loss of autonomy is both necessary and sufficient to define drug addiction.

Autonomy over Smoking (AUTOS) scale is a customized symptom checklist for assessing (loss of ) autonomy over tobacco use in smokers of all ages, symptoms increasing when taking up smoking, decreasing on quitting.

It improves upon the Hooked on Nicotine Checklist (HONC) by (1) measuring symptom intensity; (2) allowing for the evaluation of changing symptoms during uptake, during smoking and after quitting. (3) providing the ability to independently assess withdrawal, cue-induced craving and psychological dependence on cigarettes.

Responses are scored as follows: Describes me… not at all-0; a little-1; pretty well-2; very well-3. An item score >0 indicated endorsement. The instrument is scored by summing the number of symptoms endorsed. Average intensity of symptoms was calculated by summing the symptom intensities of the endorsed items and dividing by the number of symptoms endorsed.

An advantage of the autonomy concept over dependence as defined in the current psychiatric diagnostic criteria is that it provides insight into why smokers who do not meet diagnostic criteria for dependence so often fail at their attempts to quit. AUTOS could be used in clinical practice to identify obstacles to cessation in any smoker.


* Latency To Needing a Cigarette. This shortens dramatically from 10 days among those who have smoked under 100 cigarettes in their lifetime, to 2 hours for those who have smoked over 100 in their lifetime.

Ursprung WW, Morello P, Gershenson B, DiFranza JR. Development of a measure of the latency to needing a cigarette.

J Adolesc Health 2011 Apr: 48: 338-43.


DiFranza’s initial scale, the Hooked on Nicotine Checklist (HONC) proved useful in studying addiction in adolescent smoking.. (See Scragg, DiFranza, Laugesen, Wellman 2008 at

Further publications include:

DiFranza J. A new approach to the diagnosis of tobacco addiction. Addiction 2010 Mar; 105:381-2. - DiFranza.pdf

DiFranza JR, Wellman RJ, Ursprung WW, Sabiston C. The autonomy over smoking scale. Psychol Addict Behav 2009;23:656-65.PMID: 20025371 [PubMed - indexed for MEDLINE]




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