Fagerstrom Test for Nicotine Dependence
Take the validated 6-question Fagerstrom Test to assess your nicotine dependence severity and receive personalized smoking cessation guidance.
Answer all six questions honestly to get your Fagerstrom Nicotine Dependence score and understand your level of tobacco addiction.
Fagerstrom Test for Nicotine Dependence
Take the validated 6-question Fagerstrom Test to assess your nicotine dependence severity and receive personalized smoking cessation guidance.
Fagerstrom Test score examples
These examples illustrate how different smoking patterns translate into FTND scores.
| Smoking pattern | FTND score | Dependence level |
|---|---|---|
| First cigarette 31–60 min after waking, 10 or fewer/day, no restrictions difficulty, any other most hated | Score: 1 | Very Low Dependence — behavioral strategies alone are usually sufficient. |
| First cigarette 6–30 min after waking, 11–20 cigarettes/day, no restrictions difficulty, any other most hated | Score: 3 | Low Dependence — brief counseling and possible NRT recommended. |
| First cigarette 6–30 min, 21–30/day, yes to restrictions difficulty, first morning most hated, more in morning, smokes when ill | Score: 8 | High Dependence — intensive intervention and combination pharmacotherapy advised. |
| First cigarette within 5 min, 31+/day, yes to all behavioral questions | Score: 10 | Maximum score — requires the most intensive cessation support available. |
About the Fagerstrom Test
The Fagerstrom Test for Nicotine Dependence (FTND) is a six-item questionnaire developed by Karl-Olov Fagerstrom in 1978 and subsequently refined in 1991. It has become the most widely used validated instrument for measuring the intensity of physical dependence on nicotine among cigarette smokers. The test evaluates behavioral patterns related to smoking—particularly the compulsion to smoke immediately upon waking and in situations where smoking is restricted—and combines them with a quantitative measure of daily consumption to produce a total score from 0 to 10.
Each of the six questions probes a dimension of nicotine addiction that has been shown through factor analysis and validation studies to correlate strongly with plasma cotinine levels, withdrawal symptom severity, and quit success rates. The most heavily weighted questions concern how soon after waking a person lights their first cigarette (carrying up to 3 points) and how many cigarettes they smoke per day (also up to 3 points). These two items alone account for the majority of the test's predictive power and form the basis of a two-item short version sometimes used in fast-paced clinical settings.
FTND scores are grouped into four clinically meaningful bands: Very Low Dependence (0–2), Low Dependence (3–4), Moderate Dependence (5–6), and High Dependence (7–10). These categories guide treatment selection. People with very low or low scores often respond well to unaided quitting or brief counseling, while those in the moderate and high ranges typically require pharmacotherapy. The available medications—nicotine replacement therapy (patches, gum, lozenges, inhalers), bupropion, and varenicline—have all been shown to roughly double quit rates compared with placebo, and their effectiveness is greatest in those with the highest dependence scores.
The FTND is used broadly in primary care, respiratory clinics, mental health services, and community public health programs. It has been translated into dozens of languages and validated across diverse cultural and demographic groups. Despite its age, it retains strong reliability (Cronbach's alpha typically above 0.65) and remains the gold standard for brief nicotine dependence assessment in both research and clinical contexts.
It is important to understand that the Fagerstrom Test is a screening instrument, not a diagnostic tool. A high score does not mean quitting is impossible—many people with high dependence scores quit successfully with appropriate support. Similarly, a low score does not guarantee an easy quit attempt; psychological dependence and social cues can maintain smoking behavior independently of physical craving. This calculator is intended for educational purposes and should complement, not replace, personalized advice from a healthcare provider or certified smoking cessation counselor.
How to use the Fagerstrom Test calculator
- Answer each of the six questions by selecting the option that best describes your current smoking behavior.
- Be honest — the test is most useful when your answers reflect your typical habits, not your ideal behavior.
- Click Calculate Score to see your total FTND score and dependence level.
- Read the recommendation for your score level to understand which cessation strategies are most appropriate for you.
- Share your score with a healthcare provider or cessation counselor to discuss a personalized quit plan.
Fagerstrom Test FAQ
What does the Fagerstrom Test measure?
The FTND measures the physical intensity of nicotine dependence by evaluating six behavioral indicators — how quickly you smoke after waking, how many cigarettes you smoke daily, and whether smoking behavior is driven by strong compulsion. The total score from 0 to 10 reflects your overall dependence level.
What is a high Fagerstrom score?
Scores of 7 to 10 are classified as High Dependence. People in this range typically smoke more than 20 cigarettes per day, light up within the first 30 minutes of waking, and experience significant withdrawal symptoms when they try to quit. Combination pharmacotherapy is strongly recommended for this group.
Can I quit smoking even with a high score?
Yes. A high FTND score means quitting will likely be harder without support, but it does not mean success is impossible. With the right combination of behavioral counseling and medication — particularly varenicline or combination NRT — many highly dependent smokers achieve long-term abstinence.
How is the Fagerstrom score calculated?
Each answer carries a point value determined by validation research. Time to first cigarette contributes 0–3 points; cigarettes per day contributes 0–3 points; difficulty refraining, most hated cigarette, morning frequency, and smoking when ill each contribute 0–1 point. All points are summed to give a score between 0 and 10.
Is the Fagerstrom Test the same as the Heaviness of Smoking Index?
No, though they are related. The Heaviness of Smoking Index (HSI) uses only two of the six FTND items — time to first cigarette and cigarettes per day — making it even quicker to administer. The full FTND provides a more complete picture of dependence and is preferred when a thorough assessment is needed.
How often should I retake the test?
The FTND is most useful as a baseline assessment before a quit attempt and as a follow-up to track changes in dependence level over time. If you are reducing your cigarette count or have switched to a nicotine replacement product, retaking the test after 4–8 weeks can show whether your dependence level has changed and whether your cessation strategy needs adjustment.