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Fagerström Test for Nicotine Dependence Calculator

Score the Fagerström Test for Nicotine Dependence (FTND) — six questions on time to first cigarette, cigarettes per day and smoking habits — total 0–10 with the level of nicotine dependence.

1. How soon after you wake up do you smoke your first cigarette?

2. Do you find it difficult to refrain from smoking in places where it is forbidden?

3. Which cigarette would you hate most to give up?

4. How many cigarettes per day do you smoke?

5. Do you smoke more frequently during the first hours after waking than during the rest of the day?

6. Do you smoke even if you are so ill that you are in bed most of the day?

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How it works

FTND = time to first cigarette (0–3) + hard to refrain (0/1) + first cigarette most valued (0/1) + cigarettes per day (0–3) + smoke more in the morning (0/1) + smoke when ill (0/1); range 0–10. Levels: 0–2 very low · 3–4 low · 5 medium · 6–7 high · 8–10 very high.

The Fagerström Test for Nicotine Dependence (Heatherton, Kozlowski, Frecker and Fagerström, 1991) is the most widely used questionnaire for measuring physical dependence on cigarettes. Time to the first cigarette of the day and the number of cigarettes per day carry the most weight — together they form the Heaviness of Smoking Index. Higher scores predict stronger withdrawal and a need for more intensive support, such as combination nicotine replacement or varenicline, when quitting.

Worked example

A smoker who lights up 6–30 minutes after waking (2), can refrain in no-smoking areas (0), would hate most to give up the morning cigarette (1), smokes 11–20 a day (1), smokes more in the morning (1) and not when ill in bed (0) scores 5 / 10 — medium dependence.

Sources: Heatherton TF et al. The Fagerström Test for Nicotine Dependence: a revision of the FTQ. Br J Addict 1991

Frequently asked questions

What is a high Fagerström score?

Scores of 6–7 indicate high and 8–10 very high nicotine dependence. Scores of 5 or more are often used to recommend higher-dose or combination nicotine replacement.

What is the Heaviness of Smoking Index?

A two-question short form using only time to first cigarette and cigarettes per day (0–6). A score of 4 or more suggests high dependence.

Does the test work for vaping?

The original test was designed for cigarettes. Adapted versions exist for e-cigarettes, but their cut-offs are not interchangeable.

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Clinical decision tool for education and for use by trained clinicians alongside clinical judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.