🩺Fagerström Test
Take the validated Fagerström Test for Nicotine Dependence (FTND). Answer 7 questions about your smoking behaviour to receive a score from 0 to 10 and a dependence classification — from very low to very high — along with personalised quit guidance.
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Fagerström Score (0–10)
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Question Score Breakdown
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Fagerström Test for Nicotine Dependence: How Addicted Are You?
The Fagerström Test for Nicotine Dependence (FTND) is a validated 6-question scale scoring 0–10. Scores of 0–2 indicate very low dependence; 3–4 low; 5 medium; 6–7 high; 8–10 very high. The two most important questions are time to first cigarette (up to 3 points) and cigarettes per day (up to 3 points). A score ≥ 5 is the clinical threshold for recommending nicotine replacement therapy.
Scoring: Time to First Cigarette (0–3) + Cigarettes/Day (0–3) + 4 yes/no items (0–1 each) = 0–10
| Score | Dependence Level | NRT Recommended? | % of Smokers |
|---|---|---|---|
| 0–2 | Very Low | Usually not needed | ~25% |
| 5 | Medium | Recommended | ~20% |
| 8–10 | Very High | Strongly recommended | ~15% |
The Fagerström Test for Nicotine Dependence (FTND) is the most widely used validated instrument for measuring physical tobacco dependence in both clinical practice and research. Originally developed by Karl-Olov Fagerström in 1978 (as the Fagerström Tolerance Questionnaire) and revised to its current 6-item form by Heatherton and colleagues in 1991, the FTND has been translated into dozens of languages and validated in hundreds of clinical studies. It is used by smoking cessation clinics, primary care physicians, and addiction specialists worldwide to guide treatment intensity and nicotine replacement therapy (NRT) dosing.
Why the First Cigarette of the Day is the Most Important Question
The single highest-weighted question — up to 3 points — asks how soon after waking the smoker has their first cigarette. This question is so predictive because it measures whether the smoker is waking up in a state of nicotine withdrawal. After 8 hours of sleep without nicotine, blood nicotine levels have fallen substantially. A smoker who must smoke within 5 minutes of waking experiences significant physical withdrawal during the night and is driven primarily by physiological need rather than habit or situation.
In contrast, a smoker who comfortably waits 60+ minutes before their first cigarette demonstrates that they can tolerate the absence of nicotine for extended periods without distress — a strong indicator of psychological rather than physical dependence. This distinction matters clinically because physically dependent smokers have much higher relapse rates without pharmacological support (NRT, varenicline, or bupropion) and respond well to these interventions.
Nicotine Replacement Therapy: What Your Score Tells You
FTND scores guide NRT selection and dosing. Scores below 5 generally indicate that behavioural approaches (setting a quit date, identifying triggers, social support, cognitive-behavioural techniques) have a reasonable chance of success without pharmacotherapy. Scores of 5 indicate moderate dependence where NRT improves quit rates by approximately 50–70% over placebo. Scores of 6 and above indicate strong physical dependence, where combination NRT (e.g., long-acting nicotine patch + short-acting nicotine gum or lozenge) or prescription medication (varenicline/Champix/Chantix, or bupropion/Zyban) is recommended.
Varenicline (brand name Champix in Europe, Chantix in the US) is a partial nicotinic receptor agonist that reduces withdrawal symptoms and the rewarding effects of smoking. Systematic reviews show varenicline approximately doubles 12-month quit rates compared to placebo and is more effective than bupropion. For very high FTND scores (8–10), a combination of varenicline plus intensive behavioural counselling (weekly or more frequent sessions) produces the best documented quit rates — approximately 30–40% sustained abstinence at 12 months.
The Heaviness of Smoking Index (HSI)
The Heaviness of Smoking Index is a 2-item subscale of the FTND using only Questions 1 (time to first cigarette) and 4 (cigarettes per day), giving a score of 0–6. It was developed as a quick screening tool for use in large epidemiological studies and general practice settings where the full 6-item FTND may not be practical. The HSI correlates strongly with the full FTND and predicts cessation outcomes nearly as well. An HSI of 4–6 predicts heavy physical dependence; 0–1 predicts low dependence.
Frequently Asked Questions
What does my Fagerström Test score mean?
FTND scores indicate: 0–2 (very low dependence — primarily psychological/habit-based; quitting without medication is feasible); 3–4 (low dependence — NRT may not be necessary but can help); 5 (medium dependence — NRT is recommended and improves quit rates); 6–7 (high dependence — NRT or prescription medication strongly recommended); 8–10 (very high dependence — combination NRT plus intensive counselling or prescription medication like varenicline gives the best chance of success). Higher scores predict higher short-term relapse risk without pharmacological support.
How reliable is the Fagerström Test?
The FTND has strong psychometric properties: good internal consistency (Cronbach's alpha 0.55–0.74 across studies), good test-retest reliability, and predictive validity for cessation outcomes. However, like all self-report measures, it is subject to response bias — some smokers underreport consumption. The FTND measures physical (physiological) dependence specifically, not psychological craving or social/habitual dimensions of smoking. A smoker can have low physical dependence (low FTND score) but high psychological attachment to smoking — both matter for cessation.
If I score low, does that mean quitting is easy?
Low FTND scores indicate low physical/physiological nicotine dependence — meaning withdrawal symptoms are likely to be mild and short-lived. However, cigarette addiction involves multiple dimensions beyond physical dependence: habit (smoking at specific times/places), social triggers (smoking with others), stress response, and psychological craving. Many people with low FTND scores still find quitting challenging because of these psychological and behavioural components. Behavioural strategies (identifying triggers, planning responses, building social support) are especially important for psychologically- rather than physically-driven smoking.
What is the difference between the FTND and the original Fagerström Tolerance Questionnaire?
The original Fagerström Tolerance Questionnaire (FTQ, 1978) had 8 items including questions about inhalation depth and brand nicotine content. Heatherton and colleagues (1991) revised it to the current 6-item FTND by removing the two weakest items (inhalation depth and brand), improving internal consistency. The revised name "Fagerström Test for Nicotine Dependence" reflects that it is measuring dependence (a clinical construct) rather than tolerance (a pharmacological term). The FTND has been the standard instrument since 1991 and the version used in this calculator.
Can this test be used for vaping or e-cigarettes?
The FTND was designed and validated specifically for combustible cigarette smoking. While nicotine dependence from vaping shares neurobiological mechanisms with cigarette dependence, several FTND questions (time to first cigarette, cigarettes per day) do not directly translate to vaping behaviour. Modified versions for e-cigarettes exist — notably the Fagerström Test for Electronic Cigarette Dependence (FTECD) — but are less well validated. If you vape rather than smoke, the FTND provides a rough approximation, but a vape-specific tool would be more accurate.