Fagerstrom Test for Nicotine Dependence Calculator

Complete this validated 6-question assessment to determine your nicotine dependence level and get personalized smoking cessation recommendations.

The Fagerstrom Test is a widely used screening tool that helps identify the severity of nicotine dependence. Answer 6 questions to determine your addiction level and receive tailored recommendations.

Example Scenarios

Click on any example to load it into the calculator.

Very Low Dependence

Very Low Dependence

Minimal nicotine dependence with easy cessation potential.

Time to First Cigarette: After 60 minutes

Difficulty Not Smoking: No

Most Hated Cigarette: Any other

Cigarettes Per Day: 10 or less

Smoking More Morning: No

Smoking When Ill: No

Score: 1

Dependence Level: Very Low Dependence

Low Dependence

Low Dependence

Mild nicotine dependence with good cessation prospects.

Time to First Cigarette: 31-60 minutes

Difficulty Not Smoking: No

Most Hated Cigarette: Any other

Cigarettes Per Day: 11-20

Smoking More Morning: No

Smoking When Ill: No

Score: 3

Dependence Level: Low Dependence

Moderate Dependence

Moderate Dependence

Moderate nicotine dependence requiring structured cessation support.

Time to First Cigarette: 6-30 minutes

Difficulty Not Smoking: Yes

Most Hated Cigarette: The first one in the morning

Cigarettes Per Day: 21-30

Smoking More Morning: Yes

Smoking When Ill: No

Score: 6

Dependence Level: Moderate Dependence

High Dependence

High Dependence

Severe nicotine dependence requiring intensive cessation intervention.

Time to First Cigarette: Within 5 minutes

Difficulty Not Smoking: Yes

Most Hated Cigarette: The first one in the morning

Cigarettes Per Day: 31 or more

Smoking More Morning: Yes

Smoking When Ill: Yes

Score: 10

Dependence Level: High Dependence

Other Titles
Understanding Fagerstrom Test for Nicotine Dependence Calculator: A Comprehensive Guide
Learn about the validated Fagerstrom screening tool, understand nicotine dependence indicators, and identify appropriate smoking cessation strategies for better health outcomes.

What is the Fagerstrom Test for Nicotine Dependence Calculator?

  • Core Concepts and Validation
  • Why Fagerstrom Screening Matters
  • Understanding Nicotine Dependence
The Fagerstrom Test for Nicotine Dependence (FTND) is a validated, evidence-based screening tool designed to assess the severity of nicotine dependence in smokers. Developed by Dr. Karl-Olov Fagerstrom in 1978 and revised in 1991, this six-question assessment provides a reliable measure of nicotine addiction severity, helping healthcare providers and individuals determine appropriate smoking cessation strategies. The tool's scientific rigor and clinical utility have made it the gold standard for nicotine dependence assessment worldwide.
The Scientific Foundation of Fagerstrom Test
The Fagerstrom Test has been extensively validated across diverse populations and clinical settings, demonstrating excellent reliability and validity for measuring nicotine dependence. Research shows strong correlations between FTND scores and biological markers of nicotine dependence, including cotinine levels and carbon monoxide exposure. The test's ability to predict withdrawal severity, relapse risk, and treatment response makes it invaluable for personalized smoking cessation planning. Studies consistently show that higher FTND scores correlate with greater difficulty in quitting and increased need for intensive cessation support.
Understanding Nicotine Dependence
Nicotine dependence is a complex condition involving both physical and psychological components. Physical dependence manifests through withdrawal symptoms when nicotine levels drop, while psychological dependence involves learned behaviors and environmental triggers. The Fagerstrom Test specifically targets key indicators of dependence severity: morning smoking patterns, behavioral control, cigarette preference, consumption levels, and compulsion to smoke. Early identification through screening tools like FTND can lead to more effective cessation interventions and improved quit success rates.
The Six Core Questions of Fagerstrom Test
The Fagerstrom Test assesses six critical dimensions of nicotine dependence through carefully validated questions. The time to first cigarette question measures withdrawal severity and physical dependence. The difficulty refraining question evaluates behavioral control and environmental triggers. The most hated cigarette question identifies psychological attachment to specific smoking occasions. Daily consumption measures overall nicotine intake. Morning smoking patterns indicate withdrawal symptom severity. Smoking during illness demonstrates the strength of physical dependence and compulsion to use nicotine.

Key Fagerstrom Concepts:

  • Dependence Severity: Categorized scores indicating very low, low, moderate, or high dependence
  • Withdrawal Indicators: Morning smoking patterns and time to first cigarette
  • Behavioral Control: Ability to resist smoking in restricted environments
  • Treatment Planning: Score-based recommendations for cessation strategies

Step-by-Step Guide to Using the Fagerstrom Calculator

  • Accurate Response Selection
  • Understanding Scoring System
  • Interpreting Results and Next Steps
Maximizing the value of the Fagerstrom calculator requires honest, accurate responses and proper understanding of the scoring system and result interpretation. Follow this comprehensive methodology to ensure your nicotine dependence assessment provides reliable and actionable health insights.
1. Honest and Accurate Response Selection
Begin by carefully reading each question and selecting the response that most accurately reflects your current smoking behavior. Be honest with yourself—the effectiveness of the screening depends on accurate self-reporting. Consider your typical smoking patterns over the past few months, not just recent events. For the time to first cigarette question, think about your usual morning routine. For the difficulty refraining question, consider your experiences in smoke-free environments like hospitals, airplanes, or restaurants.
2. Understanding the Fagerstrom Scoring System
Each question is scored based on response options, with higher scores indicating greater nicotine dependence. The total score ranges from 0-10, with different ranges indicating dependence levels. Scores of 0-2 suggest very low dependence with good cessation prospects. Scores of 3-4 suggest low dependence with moderate cessation difficulty. Scores of 5-6 suggest moderate dependence requiring structured support. Scores of 7-10 suggest high dependence requiring intensive cessation intervention.
3. Comprehensive Result Analysis and Interpretation
The calculator provides your total score, dependence level classification, detailed interpretation of what your score means, and specific recommendations based on your dependence level. Very low dependence scores (0-2) suggest minimal withdrawal symptoms and good cessation prospects. Low dependence scores (3-4) suggest mild withdrawal symptoms and moderate cessation difficulty. Moderate dependence scores (5-6) suggest significant withdrawal symptoms and need for structured support. High dependence scores (7-10) suggest severe withdrawal symptoms and need for intensive intervention.
4. Action Planning and Cessation Strategy Development
Based on your results, develop an appropriate cessation strategy. Very low dependence individuals may succeed with minimal support and behavioral strategies. Low dependence individuals may benefit from brief counseling and nicotine replacement therapy. Moderate dependence individuals should consider comprehensive cessation programs with medication support. High dependence individuals require intensive intervention including behavioral therapy, medication, and ongoing support. Remember that FTND is a screening tool—professional evaluation is recommended for developing comprehensive cessation plans.

Response Guidelines:

  • Honest Reporting: Provide accurate responses based on your actual smoking behavior
  • Current Patterns: Consider your smoking patterns over the past few months
  • Typical Behavior: Focus on your usual smoking patterns, not exceptions
  • Morning Routines: Consider your typical morning smoking behavior

Real-World Applications and Clinical Practice

  • Healthcare Screening Programs
  • Personal Health Monitoring
  • Public Health Initiatives
The Fagerstrom calculator serves as a cornerstone for nicotine dependence assessment and smoking cessation planning across various settings, supporting both individual health monitoring and broader public health initiatives.
Healthcare and Clinical Applications
The Fagerstrom Test is widely used in primary care settings as part of routine health assessments, helping healthcare providers identify patients who need smoking cessation support. Smoking cessation clinics use FTND to determine appropriate treatment intensity and medication selection. Mental health professionals incorporate FTND into comprehensive assessments to understand the relationship between smoking and mental health conditions. The tool's validation and predictive value make it essential for evidence-based cessation planning in clinical environments.
Personal Health Monitoring and Self-Assessment
Individuals can use the Fagerstrom Test for regular self-monitoring of their nicotine dependence, helping them understand their addiction severity and plan appropriate cessation strategies. The tool can be used periodically to track changes in dependence levels over time, providing insights into addiction progression or improvement. Families and friends can use FTND to assess loved ones' nicotine dependence and determine if professional help might be needed. The calculator provides a non-threatening way to initiate conversations about smoking cessation.
Public Health and Community Programs
Public health organizations use the Fagerstrom Test in community screening programs to identify individuals at risk for smoking-related health problems. Workplace wellness programs incorporate FTND to assess employee smoking patterns and provide appropriate cessation interventions. Educational institutions use FTND in student health services to identify students who may need support with smoking cessation. The tool's simplicity and validation make it accessible for use in various community settings.

Clinical Applications:

  • Primary Care: Routine screening during health assessments
  • Cessation Clinics: Treatment planning and medication selection
  • Mental Health: Comprehensive assessment of co-occurring conditions
  • Community Health: Population-based screening programs

Understanding Dependence Levels and Clinical Implications

  • Dependence Level Classifications
  • Health Implications
  • Intervention Strategies
Understanding the different dependence levels identified by the Fagerstrom Test is crucial for appropriate cessation planning and health management. Each dependence level has specific implications for health outcomes and recommended interventions.
Very Low Dependence (Scores 0-2)
Individuals with very low dependence typically experience minimal withdrawal symptoms and have good prospects for successful cessation. They may smoke fewer than 10 cigarettes per day and can easily delay their first cigarette of the day. These individuals often succeed with minimal support, using behavioral strategies like setting quit dates, avoiding triggers, and using distraction techniques. Relapse risk is relatively low, and they may not require nicotine replacement therapy or other medications.
Low Dependence (Scores 3-4)
Individuals with low dependence experience mild withdrawal symptoms and moderate difficulty with cessation. They typically smoke 11-20 cigarettes per day and may have some difficulty refraining in restricted environments. These individuals benefit from brief counseling, behavioral support, and may consider nicotine replacement therapy for withdrawal symptom management. Success rates are good with structured support and relapse prevention strategies.
Moderate Dependence (Scores 5-6)
Individuals with moderate dependence experience significant withdrawal symptoms and require structured cessation support. They typically smoke 21-30 cigarettes per day and have difficulty controlling their smoking behavior. These individuals benefit from comprehensive cessation programs including behavioral therapy, medication support (nicotine replacement, bupropion, or varenicline), and ongoing support. Relapse risk is higher, requiring intensive follow-up and support.
High Dependence (Scores 7-10)
Individuals with high dependence experience severe withdrawal symptoms and require intensive cessation intervention. They typically smoke more than 30 cigarettes per day and have strong physical and psychological dependence. These individuals require comprehensive treatment including intensive behavioral therapy, medication combinations, and ongoing support. Relapse risk is high, requiring long-term follow-up and support systems.

Dependence Level Characteristics:

  • Very Low: Minimal withdrawal, good cessation prospects
  • Low: Mild withdrawal, moderate cessation difficulty
  • Moderate: Significant withdrawal, need for structured support
  • High: Severe withdrawal, need for intensive intervention

Mathematical Derivation and Evidence-Based Scoring

  • Scoring Algorithm Development
  • Validation Studies
  • Predictive Value Analysis
The Fagerstrom Test scoring system is based on extensive research and validation studies that have established the relationship between specific smoking behaviors and nicotine dependence severity. Understanding the mathematical foundation helps ensure accurate interpretation and appropriate clinical application.
Development of the Scoring Algorithm
The Fagerstrom Test scoring system was developed through factor analysis of multiple smoking behavior variables, identifying the six questions that best predict nicotine dependence severity. Each question's scoring weights were determined through regression analysis against biological markers of nicotine dependence, including plasma cotinine levels and carbon monoxide exposure. The total score range of 0-10 was established to provide sufficient discrimination between dependence levels while maintaining clinical utility and ease of use.
Validation Studies and Reliability
The Fagerstrom Test has been validated in numerous studies across diverse populations, demonstrating excellent internal consistency (Cronbach's alpha > 0.7) and test-retest reliability (r > 0.8). Concurrent validity has been established through correlations with biological markers of nicotine exposure, withdrawal symptom severity, and treatment outcomes. Predictive validity has been demonstrated through associations with quit success rates, relapse risk, and treatment response across different populations and settings.
Clinical Utility and Predictive Value
The Fagerstrom Test's predictive value extends beyond simple dependence assessment to treatment planning and outcome prediction. Higher scores predict greater withdrawal symptom severity, increased relapse risk, and need for more intensive treatment interventions. The tool's ability to identify individuals who will benefit from specific medications (nicotine replacement, bupropion, varenicline) has been validated in multiple clinical trials. This predictive capacity makes FTND essential for personalized smoking cessation planning and resource allocation.

Evidence-Based Applications:

  • Treatment Planning: Score-based medication and therapy selection
  • Outcome Prediction: Relapse risk and quit success probability
  • Resource Allocation: Intensive vs. minimal intervention decisions
  • Research Applications: Standardized dependence measurement