Last updated January 2010.

The Hooked On Nicotine Checklist (HONC)

1

Have you tried to quit but couldn’t?

Yes

No

2

Do you smoke now because it is really hard to quit?

Yes

No

3

Have you ever felt like you were addicted to tobacco?

Yes

No

4

Do you ever have strong cravings to smoke?

Yes

No

5

Have you ever felt like you really needed a cigarette?

Yes

No

6

Is it hard to keep from smoking in places where you are not supposed to ? (like school)

Yes

No

When you tried to stop smoking, or if you hadn’t smoked for a while…..

7

Did you find it hard to concentrate because you couldn’t smoke?

Yes

No

8

Did you feel more irritable because you couldn’t smoke?

Yes

No

9

Did you feel a strong need or urge to smoke?

Yes

No

10

Did you feel nervous, restless, or anxious?

Yes

No

 

Total score: add the yes responses:

 

 

 

The HONC measures loss of autonomy over smoking in adolescents but can be adapted for other addictions. It shows many adolescents find it difficult to quit long before they are smoking daily.

 

ASH New Zealand www.ash.org.nz has administered the HONC to over 30,000 smokers and ex-smokers at Year 10. The HONC is now used in 12 languages. Compared with the newer Loss of Autonomy over Smoking Scale, (www.healthnz.co.nz/AUTOS.htm) the HONC is a more sensitive measure of the onset of the loss of autonomy, because the HONC includes (where the AUTOS does not), an item (for example Q 9 above) to assess withdrawal-induced craving. A yes for any symptom increases risk of daily smoking within four years by 6.8 times.1

HONC predicts quitting difficulty and progression to daily smoking2

The HONC score has high predictive value. After 30 months, a HONC score of one compared with a zero score

       Increases the chances of a failed quit attempt 29 times, (excluding question 1 on the same topic).

       Increases the chances of continuing to smoke during those 30 months 44-fold.

       increases the likelihood of being a current smoker by 58-fold.2

HONC documents loss of control by one in four after first cigarette2

After one cigarette, 25% of year 10 students have an average HONC score of one or more; those who have smoked 100 cigarettes or more, have an average HONC score over 9.

The HONC measures loss of autonomy over tobacco. 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.

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1. Doubeni CA, Reed G, Difranza JR. Early course of nicotine dependence in adolescent smokers. Pediatrics 2010 June; 125: 1127-33.Epub 2010 May 3. PMID: 20439592 (4 year follow-up of 6th graders).

2. Scragg R, Wellman R, Laugesen M. DiFranza J. ‘Diminished Autonomy over Tobacco Can Appear With the First Cigarettes’ Addictive Behaviours 2008. Doi:10.1016/j.addbeh.2007.12.002 http://www.healthnz.co.nz/Addiction1stcigFeb08.pdf

3. Urspring WW, DiFranza JR. The loss of autonomy after smoking in relation to lifetime cigarette consumption. Addict Behav 2010;35:14-8. Epub 2009 Aug 10. (confirms the New Zealand study above, by showing diminished autonomy among subjects who had smoked only 1 or 2 cigarettes.)

 

Health New Zealand Ltd 2010.