What the Fagerström test measures
The Fagerström Test for Nicotine Dependence (FTND), published in 1991 by Heatherton and Fagerström, is the most widely used measure of physical dependence on cigarettes. Its six questions focus on the behaviors that reflect how strongly the body depends on nicotine, especially in the morning, after a night without smoking.
Scoring
| Question | Answers and points |
|---|---|
| First cigarette after waking | ≤5 min: 3; 6–30 min: 2; 31–60 min: 1; >60 min: 0 |
| Hard to refrain where forbidden | Yes: 1 |
| Cigarette hardest to give up | First of the morning: 1 |
| Cigarettes per day | ≤10: 0; 11–20: 1; 21–30: 2; ≥31: 3 |
| Smoke more in the morning | Yes: 1 |
| Smoke when ill in bed | Yes: 1 |
| Score | Dependence |
|---|---|
| 0–2 | Very low |
| 3–4 | Low |
| 5 | Moderate |
| 6–7 | High |
| 8–10 | Very high |
Worked example
Someone smokes their first cigarette 15 minutes after waking (2), has no trouble refraining where smoking is forbidden (0), would hate most to give up the first cigarette (1), smokes 15 a day (1) and answers no to the last two questions: 4 points, low dependence. The Heaviness of Smoking Index, time to first cigarette plus cigarettes per day, is 3 out of 6.
Using the score to quit
- Low dependence: behavioral support alone may be enough, though nicotine replacement still helps.
- Moderate to high dependence: combine a nicotine patch with a fast-acting form (gum, lozenge, inhaler), or use varenicline or bupropion prescribed by a doctor.
- People who smoke within 30 minutes of waking usually start with a 21 mg patch if they smoke more than 10 cigarettes a day.
Using medication with counseling roughly doubles the chance of quitting compared with willpower alone.
Withdrawal
Cravings, irritability, poor concentration, increased appetite and sleep changes peak in the first week and fade over 2 to 4 weeks. A higher score predicts stronger symptoms, which is a reason to use enough nicotine replacement rather than to delay quitting.
Free help
Call 1-800-QUIT-NOW (1-800-784-8669) for free coaching from your state quitline, or visit smokefree.gov for text and app programs.
This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.