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Fagerström Test for Nicotine Dependence (FTND)

Complete these six evidence-based questions. Higher scores indicate higher physiological dependence and need for pharmacological support.

Completion: 0% (0 of 6 answered)

How soon after you wake do you smoke your first cigarette?

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

Which cigarette would you hate most to give up?

How many cigarettes per day do you smoke?

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

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

FTND score

0

Range 0–10

Dependence level

Very low nicotine dependence

Brief advice may suffice. Encourage complete cessation and consider behavioural strategies.
Combine FTND results with patient preferences, quit history, comorbidities, and pregnancy status when selecting cessation medications and intensity of behavioural support.

How to Use This Calculator

1

Assess current smoking behaviour

Answer based on regular patterns over the last month. For e-cigarettes, adapt by considering nicotine concentration and usage frequency.

2

Interpret cut-off scores

Higher scores correspond to greater nicotine dependence and higher likelihood of withdrawal symptoms during cessation.

3

Tailor treatment intensity

Use the score to select pharmacotherapy (combination NRT, varenicline, bupropion) and behavioural programmes (phone, group, digital).

Formula

Total FTND score = Sum of item scores:

  • Items 1 and 4 scored 0–3
  • Items 2, 3, 5, 6 scored 0–1

Dependence levels:

  • 0–2: Very low
  • 3–4: Low
  • 5–6: Medium
  • 7–8: High
  • 9–10: Very high

Full Description

The Fagerström Test for Nicotine Dependence quantifies physiological addiction based on time to first cigarette, cigarettes per day, and withdrawal-related behaviours. Scores predict withdrawal severity and inform cessation pharmacotherapy. Combine FTND with carbon monoxide or cotinine monitoring, motivational interviewing, and follow-up support to improve quit rates. Address co-occurring mental health conditions and provide relapse prevention planning.

Frequently Asked Questions

Does the test apply to vaping?

Not directly, but you can interpret high-frequency vaping with nicotine as equivalent. Consider the Penn State Electronic Cigarette Dependence Index for vapers.

How often should I repeat FTND?

Use at baseline and during follow-up to gauge reduction in dependence. Falling scores indicate improved control.

Is FTND predictive of quit success?

Higher scores correlate with more challenging quits. Combine pharmacotherapy and behavioural support for best outcomes.

Can pregnant individuals use FTND?

Yes, but cessation plans must prioritise behavioural therapy and clinician-guided pharmacotherapy due to pregnancy considerations.