HealthScorer

Fagerström Nicotine Dependence Test (FTND)

Take the validated 6-question Fagerström FTND in 60 seconds. Heatherton 1991, used in primary care. Free, no signup, results stay in your browser.

Last updated: Sources verified:

What you are about to take

The Fagerström Test for Nicotine Dependence (FTND) measures how strongly nicotine has its grip on your daily routine. Six questions cover how soon after waking you smoke, how many cigarettes per day, and whether you smoke when ill. About 60 seconds. No signup. The FTND was developed by Heatherton, Kozlowski, Frecker, and Fagerström in 1991, published in the British Journal of Addiction, and Taylor & Francis later issued an explicit public-domain waiver — clinicians worldwide use it without licensing. The US Surgeon General 2020 Smoking Cessation Report and the WHO MPOWER framework both reference it as the standard tobacco-dependence screener. Your answers stay in your browser — we never see them. Start the test below ↓

✓ Validated by Heatherton, Kozlowski, Frecker, Fagerström (1991, Br J Addict) ✓ Referenced in US Surgeon General 2020 Smoking Cessation Report ✓ 60 seconds, 6 questions ✓ Private — answers never leave your device

How the Fagerström FTND is calculated

You answer six items about your current smoking. Items 1 and 4 (time to first cigarette, cigarettes per day) score 0–3 each. Items 2, 3, 5, and 6 (forbidden-place difficulty, hardest-to-give-up cigarette, morning frequency, smoking-when-ill) score 0–1 each. The six items sum to a single total between 0 and 10.

Total scoreBandDependence levelWhat the band typically means
0–2Very lowMinimal physiological gripBrief counselling alone usually enough; baseline first-try quit rate ~25–30%
3–4LowHabit established but not waking with cravingsNRT for 4–6 weeks plus quitline doubles quit success
5MediumPharmacotherapy stops being optionalVarenicline or NRT combination + counselling
6–7HighStrong physiological dependenceCombination medication + structured support — willpower alone <5% (Hughes 2004)
8–10Very highTop of the dependence scaleVarenicline + counselling reaches ~25% sustained 6-month quit

The band matters more than the raw number. Heatherton 1991 used the bands as the clinical-decision thresholds; a one-band shift between FTND administrations is a real signal that something has changed in the underlying physiological grip.

When this test is useful — and when it isn’t

Useful for:

  • Bringing a quantified dependence score to a GP visit instead of “I smoke too much”
  • Choosing whether NRT alone is enough or whether prescription medication (varenicline, bupropion) makes sense
  • Identifying which item of the dependence pattern (morning cigarette? cigarettes-per-day? smoking when ill?) is the biggest grip — useful for picking which behavioural strategy to target first

Not useful for:

  • Vaping or e-cigarette dependence — the original FTND was validated for combustible cigarettes only; a modified version (Foulds 2015) exists but is not standard primary care
  • Smokeless tobacco (chewing tobacco, snus) — a separate FTND-ST exists for that
  • Predicting health damage — the FTND measures dependence, not cumulative exposure or organ damage; a pack-year history does the latter

Fagerström dependence vs cumulative exposure vs cardiovascular damage

A common confusion: people equate “high FTND” with “highest health damage”. They are related but distinct.

Dependence (FTND) measures how strongly nicotine drives your daily behaviour right now. Cumulative exposure (pack-years: packs/day × years smoked) tracks the lifetime dose. Damage (FEV1, coronary calcium, peripheral arterial disease) measures the actual physiological consequence. Someone with FTND 8 who has smoked for 5 years has much lower cumulative damage than someone with FTND 4 who has smoked for 40 years. All three numbers belong on a doctor’s visit. The strongest single act for cardiovascular and cancer risk, regardless of cumulative exposure to date, is to quit — the US Surgeon General 2014 Report shows cardiovascular risk roughly halves within 1 year of quitting and lung cancer risk halves within 5–10 years.

  • AUDIT-C alcohol use screener — alcohol and tobacco use frequently co-occur; quit attempts during active heavy drinking fail more often
  • PHQ-9 depression screener — depression is the most common comorbidity that derails quit attempts (US Surgeon General 2020)
  • GAD-7 anxiety screener — anxiety overlaps with nicotine withdrawal and is the third-most-common reason quit attempts stall

Sources verified 2026-05-17

  • Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. British Journal of Addiction 1991;86(9):1119-1127. (PMID 1932883)
  • US Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta: CDC, 2020.
  • World Health Organization. MPOWER: A policy package to reverse the tobacco epidemic. WHO Framework Convention on Tobacco Control, 2008 (last update 2023).
  • Cahill K, Lindson-Hawley N, Thomas KH, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2016. (PMID 27158893)
  • Chaiton M, Diemert L, Cohen JE, et al. Estimating the number of quit attempts it takes to quit smoking successfully. BMJ Open 2016;6:e011045.
  • Centers for Disease Control and Prevention. Tips From Former Smokers campaign and 1-800-QUIT-NOW national quitline. Accessed 2026-05-17.

Privacy

The FTND calculation runs entirely in your browser. Your individual answers and the calculated dependence band never leave your device. We send one anonymous event to a privacy-respecting analytics service: your locale code and the FTND band string (for example band_high). No raw answers, no per-item data, no identifier of any kind.

Frequently asked questions

What does a Fagerström score of 6 mean?
A Fagerström score of 6 places you in the high-dependence band (range 6–7). Heatherton 1991 set this cutoff as the level where physiological dependence is firmly established and willpower-alone quit attempts succeed less than 5% on the first try (Hughes 2004, Addiction). At this band, varenicline (Chantix) or NRT combination plus behavioural support roughly triples quit success vs. placebo (Cahill 2016, Cochrane review).
What does a Fagerström score of 8 mean?
A score of 8 sits in the very-high band (8–10), the top of the dependence scale. It reflects very early morning smoking, heavy daily use, and smoking even when severely ill. With varenicline plus structured counselling, 6-month sustained quit rates at this band are around 25% — many times higher than the willpower-alone baseline (US Surgeon General 2020 Smoking Cessation Report).
How addicted to nicotine am I if I score 0–2?
0–2 is the very-low dependence band in Heatherton 1991. Nicotine has a foothold but is not running your day, and quit attempts in this band succeed roughly 25–30% on the first try with brief counselling alone (Fiore 2008, US Public Health Service guideline). Even at this score, occasional smoking still raises cardiovascular and cancer risk meaningfully (Bjartveit 2005, Tobacco Control).
At what FTND score should I see a doctor about quitting?
From a Fagerström score of 5 onwards, pharmacotherapy stops being optional for most people. Heatherton 1991 places this as the medium-dependence threshold. The US Surgeon General 2020 Smoking Cessation Report and the 2008 US Public Health Service guideline both recommend a GP or pharmacist consultation about varenicline, NRT combination, or bupropion at FTND ≥ 5.
How do I quit smoking with a high FTND score?
Combine medication and behavioural support — that combination roughly doubles the effect of either alone. Varenicline (12-week course) is the evidence-strongest single agent (OR ~2.7 vs placebo, Cahill 2016). NRT combination (a 21 mg patch plus 2–4 mg gum or lozenges as needed) is a strong alternative. Call 1-800-QUIT-NOW (US) or visit NHS Stop Smoking Services for free counselling alongside the medication.
Fagerström test vs AUDIT-C — which one do I need?
Different substances. The Fagerström FTND screens for nicotine dependence in current smokers; AUDIT-C screens for hazardous alcohol use. The FTND looks at how quickly after waking you smoke, how many cigarettes per day, and whether you smoke when ill. AUDIT-C looks at frequency and quantity of alcohol use. If you smoke and drink, taking both is reasonable — they assess separate clinical questions.
Is the Fagerström test for vaping or e-cigarettes valid?
The original FTND was validated for combustible cigarettes (Heatherton 1991), not vaping. A modified Fagerström for e-cigarettes (Foulds 2015, Nicotine Tob Res) has been studied but is not yet a standard primary-care tool. If you vape, use the FTND as a rough indicator only — a clinician's interview is the better next step. Vaping nicotine still causes dependence; the strength varies hugely by device and liquid concentration.
How often should I retake the Fagerström test when quitting?
Retake the FTND if you are still smoking and want to track changes in your dependence pattern. Once you have quit, the questions no longer apply — the test measures current smoking behaviour. A reasonable schedule while still smoking: every 4–6 weeks if you are tapering, or before and after a serious medication-supported quit attempt to compare baseline with relapse-period dependence.
Heavy smoker vs occasional — does FTND apply to both?
Yes. The FTND was designed across the full range of smoking patterns. Occasional smokers usually score 0–4 (very-low or low dependence), heavy daily smokers usually score 6–10. The morning-cigarette and time-to-first-cigarette items are weighted more heavily than cigarettes-per-day, because they capture physiological dependence better than raw quantity (Heatherton 1991).
Why is the morning cigarette so heavily weighted in FTND?
Time to first cigarette after waking is the single strongest predictor of nicotine dependence in Heatherton 1991. Smoking within 5 minutes of waking means overnight nicotine receptor withdrawal is already pulling — a physiological signal, not a habit choice. That is why item 1 carries a maximum of 3 points, the same as the cigarettes-per-day item, despite being a single behaviour.
Can my Fagerström score be wrong if I have low daily count but heavy emotional dependence?
Yes. The FTND measures physiological dependence on nicotine — the morning cigarette, the inability to refrain in no-smoking settings, smoking when ill. Someone who smokes only 5 cigarettes per day but smokes their first within 5 minutes of waking can still score in the medium band. Emotional or habit-cued cravings are real but not what the FTND captures; a structured tobacco-treatment interview catches both layers.
Is nicotine dependence a moral failure?
No. The US Surgeon General 2020 Smoking Cessation Report states explicitly that nicotine dependence is a chronic medical condition driven by receptor adaptation, not weak willpower. Nicotine has reinforcement comparable to cocaine in standard animal models (Henningfield 1985, Br J Addict). Most successful long-term quitters needed 4–6 serious attempts (Chaiton 2016, BMJ Open) — relapse is data, not character.
What is the best free quit-smoking helpline in the US?
Call 1-800-QUIT-NOW (1-800-784-8669). It is the US national quitline, free and confidential, operated through the CDC-funded National Network of Tobacco Cessation Quitlines. Many states also offer free NRT (patches or gum) to callers. The CDC Tips From Former Smokers campaign and Smokefree.gov are the two main online cessation resources.
How long does nicotine withdrawal last?
Acute withdrawal peaks at 48–72 hours and is largely gone by week 3 (American Psychiatric Association DSM-5). Irritability, sleep disturbance, anxiety, intense cravings, and concentration problems are typical. Cravings beyond week 3 are usually habit-cued rather than pharmacological — shorter (under 5 minutes typically) and triggered by specific contexts like coffee, alcohol, or stress.
Does my Fagerström test stay private?
Yes. The calculator runs entirely in your browser. Your individual answers never leave your device. We log one anonymous event with the Fagerström dependence band (e.g. `band_high`), nothing more — no raw answers, no IP, no identifier.

Sources

  1. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire — Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO — British Journal of Addiction (1991) (peer reviewed, retrieved 2026-05-17)
  2. Smoking Cessation: A Report of the Surgeon General — US Department of Health and Human Services / Surgeon General (2020) (guideline, retrieved 2026-05-17)
  3. WHO Framework Convention on Tobacco Control — MPOWER package — World Health Organization (2008/2023 update) (guideline, retrieved 2026-05-17)
  4. Tips From Former Smokers — campaign and cessation resources — Centers for Disease Control and Prevention (CDC) (gov health, retrieved 2026-05-17)
  5. 1-800-QUIT-NOW — National Quitline — CDC / National Network of Tobacco Cessation Quitlines (NNTCQ) (gov health, retrieved 2026-05-17)