Fagerstrom Test for Nicotine Dependence (FTND) Calculator
Answer the six standardised questions below to get your Fagerstrom Test for Nicotine Dependence (FTND) score. The score ranges from 0 to 10 and places you in one of five dependence bands, from very low to very high. The result comes with a plain-English interpretation and guidance on what your score means for choosing a cessation strategy.
What is the Fagerstrom Test for Nicotine Dependence?
The Fagerstrom Test for Nicotine Dependence (FTND) is a standardised six-item questionnaire that measures the intensity of physical nicotine addiction. It was developed by Swedish psychologist Karl-Olov Fagerstrom in 1978 and revised in 1991 by Heatherton and colleagues to strengthen its psychometric properties. The test has been validated in dozens of languages and is widely used in clinical practice, smoking-cessation programs, and tobacco research. Scores range from 0 to 10, with higher scores reflecting greater pharmacological dependence on nicotine. Questions 1 (time to first cigarette) and 4 (daily consumption) each carry up to 3 points and are the strongest predictors of dependence severity; the remaining four questions each contribute 0 or 1 point.
How to interpret your FTND score
Scores from 0 to 2 indicate very low physical dependence, meaning that psychological habit and social cues are the main drivers of smoking rather than pharmacological need. Scores of 3-4 suggest low dependence, where brief support and low-dose nicotine replacement therapy (NRT) are usually sufficient. A score of 5-6 falls in the moderate range and typically warrants a combination NRT strategy (a slow-release patch paired with fast-acting gum, lozenge, or mouth spray) together with behavioural counselling. Scores of 7-8 indicate high dependence, and scores of 9-10 indicate very high dependence, both of which are associated with more severe withdrawal symptoms and a substantially higher relapse risk without pharmacological support. At these levels, prescription options such as varenicline (Champix/Chantix) or bupropion, and referral to a specialist cessation clinic, are strongly recommended.
The Heaviness of Smoking Index (HSI)
The Heaviness of Smoking Index (HSI) is a two-item abbreviation of the FTND that uses only questions 1 and 4, time to first cigarette and cigarettes per day. It produces a score from 0 to 6 and correlates strongly with the full FTND. The HSI is widely used in epidemiological studies and brief clinical screens when time does not permit the full six-item instrument. This calculator displays both scores so you can see how the two-item version compares to the complete test for your profile.
Using the FTND to choose a cessation strategy
The FTND score is most useful as a guide to treatment intensity rather than as a pass-fail judgment. Smokers at very low dependence levels often succeed with willpower, self-help materials, and brief advice. At moderate levels, the combination of NRT and a structured quit plan doubles the odds of success compared to unassisted attempts. At high and very high levels, pharmacotherapy significantly outperforms NRT alone: varenicline approximately triples the rate of sustained abstinence at 12 months compared to placebo, and bupropion roughly doubles it. Behavioural support from a cessation counsellor adds further benefit independent of any pharmacological treatment. Retesting two to four weeks after a quit attempt or dose adjustment can help track whether dependence-related symptoms are easing.
FTND score interpretation
| FTND score | Dependence level | Typical cessation approach |
|---|---|---|
| 0-2 | Very low | Brief counselling, self-help materials |
| 3-4 | Low | Low-dose NRT or brief behavioural support |
| 5-6 | Moderate | Standard NRT (patch + fast-acting form), counselling |
| 7-8 | High | Combination NRT or prescription pharmacotherapy + support |
| 9-10 | Very high | Prescription medication (varenicline), intensive behavioural therapy |
Standard clinical interpretation bands for the Fagerstrom Test for Nicotine Dependence (0-10 scale). Cessation guidance aligns with WHO and national tobacco treatment guidelines.
Frequently asked questions
What is the Fagerstrom Test for Nicotine Dependence?
The FTND is a validated six-question clinical tool that measures how physically dependent a smoker is on nicotine. Scores range from 0 (no dependence) to 10 (very high dependence). It has been in clinical use since the 1970s and is the most widely adopted instrument of its kind for guiding smoking-cessation treatment.
Is a score of 5 considered high?
A score of 5 sits at the boundary between the moderate band (5-6) and the low band (3-4). It suggests meaningful physical dependence: you are likely to experience noticeable withdrawal symptoms when quitting, and NRT or other pharmacological support will improve your chances of success. A score of 7 or above is considered high, and 9-10 is very high.
Why does the first cigarette of the day carry so many points?
The time between waking and lighting the first cigarette is the most powerful single predictor of nicotine dependence. After a night of abstinence, blood nicotine levels drop, and withdrawal symptoms begin to build during sleep. Reaching for a cigarette within minutes of waking indicates a strong physiological drive to restore nicotine levels, which is the hallmark of physical addiction rather than habit.
Can I use the FTND if I vape instead of smoke?
The standard FTND was developed and validated specifically for cigarette smoking. While nicotine dependence from vaping is real and can be severe, there is no universally accepted adapted version of the FTND for e-cigarettes. Alternative tools such as the Penn State E-Cigarette Dependence Index have been developed for that purpose. This calculator should be used only by people who smoke cigarettes or tobacco.
How is the FTND different from the Heaviness of Smoking Index?
The HSI uses only two of the six FTND questions: time to first cigarette (0-3 points) and daily cigarette count (0-3 points), giving a score from 0 to 6. It sacrifices some precision for speed, making it useful in settings where a full assessment is not possible. This calculator reports both scores so you can compare them.
Does my FTND score predict whether I will succeed in quitting?
Higher scores are associated with lower unaided quit rates and greater severity of withdrawal, but the FTND does not predict success on its own. Many heavily dependent smokers quit successfully with the right pharmacological and behavioural support. Think of the score as a guide to how much support you are likely to need, not as a verdict on your willpower or chances.
Sources
- Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction. 1991;86(9):1119-1127.
- Etter JF, Duc TV, Perneger TV. Validity of the Fagerstrom Test for Nicotine Dependence and of the Heaviness of Smoking Index among relatively light smokers. Addiction. 1999;94(2):269-281.