π Fagerstrom Nicotine Dependence Test
Six questions that measure how hooked you are.
For informational purposes only, not medical advice. Consult a healthcare professional.
The Fagerstrom Test for Nicotine Dependence scores 6 questions from 0 to 10: 0-2 is very low, 3-4 low, 5 moderate, 6-7 high, and 8-10 very high dependence. The single most telling question is how soon you smoke after waking. Answer all six above for your score and what it means for quitting.
How to Take This Test
Karl Fagerstrom published the original tolerance questionnaire in 1978; the revised 6-item test is the global standard for measuring physical nicotine dependence. Answer for your current smoking.
Answer all six questions honestly. They cover time to first cigarette, difficulty refraining, the most valued cigarette, daily count, morning heaviness, and smoking through illness.
Read your score out of 10 and the dependence band. The band guides how much medication support your quit attempt should include.
Use the band to plan: very low scores can often quit with behavioral support alone; moderate and up should strongly consider pharmacotherapy, which roughly doubles quit rates.
How FTND Scoring Works
Two questions carry triple weight: time to first cigarette and cigarettes per day, because they best capture overnight withdrawal and total nicotine intake. The morning questions (1, 3, 5) cluster together for a reason: after 8 hours of sleep, a dependent smoker wakes in withdrawal, and how fast they relieve it measures dependence directly. Someone who smokes within 5 minutes of waking (3 points) and goes through 31+ cigarettes (3 points) is already at 6 before the other questions, which is exactly right: that pattern is heavily dependent by any measure.
Worked Example
First cigarette within 5 minutes (3), difficult to refrain where forbidden (1), would hate to give up the first of the day (1), 11-20 cigarettes daily (1), smokes more in the morning (1), does not smoke in bed ill (0). Total: 3+1+1+1+1+0 = 7, high dependence. The morning cluster contributes 5 of the 7 points, the classic dependent pattern. Contrast: first cigarette after 60 minutes (0), no difficulty refraining (0), any other cigarette hardest (0), 10 or fewer daily (0), no morning heaviness (0), no smoking ill (0) = 0, very low dependence. Same test, opposite ends, and the quit plans differ accordingly.
What Your Band Means for Quitting
| Score | Band | Recommended support |
|---|---|---|
| 0 - 2 | Very low | Behavioral strategies; NRT optional |
| 3 - 4 | Low | NRT (patch + short-acting) or varenicline advised |
| 5 | Moderate | Pharmacotherapy strongly recommended |
| 6 - 7 | High | Combination therapy + counseling; plan before quit day |
| 8 - 10 | Very high | Structured plan with clinician; combination therapy |
The evidence behind the medication advice is strong: combination NRT (patch plus gum or lozenge) beats single NRT, varenicline beats single NRT, and adding behavioral counseling beats going alone at every level. Higher scores predict worse withdrawal (irritability, craving, poor concentration peaking at 2-3 days, easing over 2-4 weeks) and benefit most from starting medication 1-2 weeks before quit day. In the US, 1-800-QUIT-NOW connects you to free coaching and often free NRT starter kits by state. For related substance screening, our DUDIT drug use test covers other drugs, and our GAD-7 screens the anxiety that often rides along with quit attempts.
Vaping and the Fagerstrom
The FTND was built for cigarettes, and vaping complicates two questions: "cigarettes per day" has no direct equivalent, and nicotine concentrations vary wildly by device. Researchers adapt it by mapping vaping sessions or milliliters of e-liquid to cigarette bands, but no consensus conversion exists. As a rough guide, all-day vaping with high-nicotine salts behaves like moderate-to-high dependence regardless of the exact score. If you both smoke and vape, answer for cigarettes and note the vaping separately; dual users typically score higher and need combination therapy.
What the Test Misses
FTND measures physical dependence, not the behavioral and psychological grip: the after-meal cigarette, the work-break ritual, the stress response. Light or intermittent smokers can score 0-2 yet struggle to quit because the habit architecture is strong. Social and mental-health context (depression roughly doubles smoking rates and halves quit rates) matters as much as the number. Use the score to dose the pharmacotherapy, and use counseling or quitlines to dismantle the habits; the two together are what the guidelines recommend.
When to Retake the Test
Dependence changes, so the score is a snapshot. Retake after cutting down (scores often fall as consumption drops), when switching to vaping, or during a quit attempt to see whether medication is covering withdrawal. A score that stays high despite cutting cigarettes in half suggests compensatory smoking: deeper inhalation per cigarette, which is why cotinine sometimes barely moves. Use the retest to adjust the plan, not to grade yourself.
Keep your completed answers; showing the item pattern to a clinician or quitline coach (especially the morning questions) helps them tailor medication timing, like dosing NRT before the first craving hits.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is a high Fagerstrom score?
6-7 is high dependence and 8-10 is very high. High scorers typically smoke within 30 minutes of waking, smoke 20+ daily, and experience significant withdrawal; combination pharmacotherapy plus counseling is recommended.
What does the Fagerstrom test measure?
Physical nicotine dependence across 6 questions (0-10 points). It predicts withdrawal severity and guides how intensive quit-smoking medication support should be. It does not measure motivation or habit strength.
How accurate is the Fagerstrom test?
Well validated: scores correlate with nicotine intake biomarkers (cotinine), withdrawal severity, and quit difficulty. It is the most widely used dependence measure in research and clinical practice worldwide.
What is the most important Fagerstrom question?
Time to first cigarette after waking. Smoking within 5 minutes is the single strongest indicator of dependence; it alone contributes up to 3 of the 10 points.
Can I use Fagerstrom for vaping?
Approximately. The test was designed for cigarettes, so the cigarettes-per-day question needs adaptation (sessions or mL of e-liquid). Heavy daily vaping generally indicates moderate-to-high dependence regardless of exact scoring.
What score means I need medication to quit?
Scores of 3+ benefit meaningfully from pharmacotherapy, and 5+ should strongly consider it. Medication roughly doubles quit rates; at high scores, combination NRT or varenicline plus counseling is the guideline-backed approach.
How long does nicotine withdrawal last?
Peak at 2-3 days, most symptoms ease over 2-4 weeks. Cravings can recur for months but shorten and weaken. Higher Fagerstrom scores predict more intense early withdrawal.
What is 1-800-QUIT-NOW?
The US national quitline portal: free coaching, quit planning, and often free NRT starter kits, routed to your state's program. Available in English, Spanish, and other languages. Text programs are also available.
Does the Fagerstrom test work for smokeless tobacco?
There is a separate adapted version (FTND-ST) for smokeless tobacco. The cigarette version's questions about smoking behavior do not translate directly to chew or snus.
I scored low but cannot quit. Why?
The FTND measures physical dependence only. Behavioral rituals, stress links, and co-occurring depression or anxiety drive many quit failures at low scores. Counseling and quitlines address exactly these factors.