Last updated August 2009

AUTOS (Autonomy over Smoking Checklist) (adolescents & adults)

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……………….

Di Franza J, Wellman RJ, Ursprung S. Society for Research on Nicotine and Tobacco (SRNT) Paper 11-5. 2008

	Withdrawal Symptoms (put a ü in the column that best describes me)	Not at all =0	A little =1	Pretty well = 2	Very well = 3
1	When I go too long without a cigarette I get impatient
2	When I go too long without a cigarette I get strong urges that are hard to get rid of
3	When I go too long without a cigarette I lose my temper more easily
4	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
5	I rely on smoking to focus my attention
6	I rely on smoking to take my mind off being bored
7	I rely on smoking to deal with stress
8	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
9	When I feel stressed I want a cigarette
10	When I see other people smoking I want a cigarette
11	When I smell cigarette smoke I want a cigarette
12	After eating I want a cigarette
All	Total of endorsements (1 to 12) Autos endorsements (score 1-12) For these, score each in the 1, 2 or 3 score column Symptom intensity (up to 36 symptom scores/up to 12 endorsements.)	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. 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 http://www.healthnz.co.nz/Addiction1stcigFeb08.pdf) Further publications include: DiFranza J. A new approach to the diagnosis of tobacco addiction. Addiction 2010 Mar; 105:381-2. www.healthnz.co.nz/Addiction - DiFranza.pdf DiFranza JR, Wellman RJ, Ursprung WW, Sabiston C. The Autonomy over smoking scale. Psychol Addict Behav. 2009 Dec;23(4):656-65.

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