Fagerström Test for Nicotine Dependence - Assess Your Addiction Level
Take the scientifically validated Fagerström Test to measure your physical dependence on nicotine. This standardized assessment helps healthcare professionals and smokers understand addiction severity and plan appropriate treatment strategies. Get personalized insights based on your smoking patterns and dependence level.
Fagerström Test Questions
Your Results
Complete all 6 questions to see your results
0/6 questions answered
About the Test
Scientific Validity
✓ Clinically validated assessment
✓ Used by healthcare professionals
✓ Peer-reviewed research backing
✓ WHO recognized standard
Score Interpretation
Test Purpose
• Assess nicotine addiction severity
• Guide treatment decisions
• Predict withdrawal symptoms
• Monitor cessation progress
• Research and clinical use
Important Notes
• Self-assessment tool only
• Not a medical diagnosis
• Consult healthcare professionals
• Individual results may vary
Next Steps
1. Discuss results with your doctor
2. Consider cessation programs
3. Explore treatment options
4. Join support groups
5. Set a quit date
Last updated: November 2 2025
Curated by the QuickTooly Team
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Understanding Nicotine Dependence and the Fagerström Test
The Fagerström Test for Nicotine Dependence (FTND) is the most widely used clinical tool for assessing the intensity of physical addiction to nicotine. Developed by Swedish researcher Karl Fagerström in 1978 and revised in 1991, this six-question assessment provides healthcare professionals and individuals with a standardized method to evaluate smoking addiction severity.
The test focuses on behavioral patterns that indicate physical dependence rather than psychological aspects of smoking. It emphasizes timing of smoking behavior, particularly morning smoking patterns, as these are strong indicators of nicotine withdrawal and physical addiction. Scores range from 0-10, with higher scores indicating greater physical dependence and typically predicting more severe withdrawal symptoms during quit attempts.
Clinical Applications and Treatment Planning
Healthcare professionals use Fagerström scores to develop personalized treatment strategies and predict patient outcomes during smoking cessation attempts. The assessment helps determine appropriate intervention levels and medication needs:
- Low Dependence (0-4): Behavioral interventions, self-help materials, and minimal pharmacotherapy may be sufficient. Success rates with these approaches are generally higher, and withdrawal symptoms tend to be milder and shorter in duration.
- Medium Dependence (5): Combination approaches including behavioral support and nicotine replacement therapy are typically recommended. Structured cessation programs provide additional support during the critical early quit period.
- High Dependence (6-10): Intensive interventions including prescription medications (varenicline, bupropion), high-dose nicotine replacement, behavioral counseling, and potentially multiple quit attempts with professional support are usually necessary for success.
Withdrawal Symptoms Based on Dependence Level
The Fagerström score helps predict the intensity and duration of withdrawal symptoms when quitting smoking. Understanding what to expect can improve preparation and success rates:
Physical Withdrawal Timeline
Peak withdrawal symptoms typically occur 24-72 hours after quitting and may include irritability, anxiety, difficulty concentrating, restlessness, increased appetite, sleep disturbances, and intense cravings. Higher Fagerström scores correlate with more severe and prolonged symptoms, often lasting 2-4 weeks for the acute phase.
Psychological Dependence Factors
While the Fagerström test measures physical dependence, psychological aspects like smoking triggers, stress management, and habitual behaviors also influence quit success. Comprehensive treatment addresses both physical addiction and behavioral patterns for optimal outcomes.
Individual Variation
Withdrawal experiences vary significantly between individuals, even with similar Fagerström scores. Factors including genetics, mental health status, social support, motivation level, and previous quit attempts all influence the cessation experience and should be considered in treatment planning.
Pharmacotherapy Recommendations by Dependence Level
Medication choices for smoking cessation are often guided by Fagerström scores, with higher dependence typically requiring more intensive pharmacological intervention:
- Nicotine Replacement Therapy (NRT): Available in patches, gum, lozenges, inhalers, and nasal sprays. Higher dependence scores may benefit from combination NRT (patch plus short-acting form) to manage both baseline nicotine levels and breakthrough cravings.
- Varenicline (Chantix): Particularly effective for highly dependent smokers (scores 6+). Reduces withdrawal symptoms and smoking satisfaction by partially blocking nicotinic receptors while providing some receptor activation.
- Bupropion (Zyban): Antidepressant that reduces withdrawal symptoms and cravings. May be especially helpful for smokers with depression history or concerns about post-cessation weight gain.
- Combination Therapies: Highly dependent smokers may benefit from combining medications (with medical supervision) or combining pharmacotherapy with intensive behavioral interventions for maximum effectiveness.
Behavioral Strategies Tailored to Dependence Level
Low to Medium Dependence Strategies
Self-help materials, mobile apps, and brief counseling sessions may be sufficient. Focus on identifying triggers, developing coping strategies, and gradual reduction techniques. Online support communities and quitlines provide accessible assistance without intensive professional involvement.
High Dependence Interventions
Intensive behavioral counseling, group therapy, cognitive-behavioral therapy (CBT), and structured cessation programs are typically necessary. Multiple sessions over several months help address complex addiction patterns and prevent relapse during vulnerable periods.
Relapse Prevention Planning
Higher dependence scores indicate greater relapse risk, necessitating comprehensive prevention strategies. This includes identifying high-risk situations, developing alternative coping mechanisms, building social support networks, and creating detailed action plans for managing cravings and stressful situations.
Scientific Research and Test Validation
Extensive research supports the Fagerström Test's reliability and validity across diverse populations and clinical settings:
Predictive Validity
Studies consistently show that higher Fagerström scores predict more severe withdrawal symptoms, greater difficulty quitting, higher relapse rates, and need for more intensive treatment interventions. The test effectively identifies patients who require enhanced support during cessation attempts.
Cross-Cultural Applications
The test has been validated across different cultures, languages, and smoking patterns worldwide. While some cultural variations in smoking behaviors exist, the core relationship between test scores and dependence severity remains consistent across populations.
Ongoing Research
Current research explores modifications for e-cigarette users, genetic factors influencing nicotine metabolism, and integration with biomarkers for more precise addiction assessment. These developments may lead to more personalized treatment approaches in the future.
Frequently Asked Questions About the Fagerström Test
How accurate is the Fagerström Test?
The test shows good reliability and validity for assessing physical nicotine dependence. However, it measures only one aspect of smoking addiction and should be used alongside clinical assessment and consideration of psychological, social, and behavioral factors that influence smoking cessation success.
Can the test be used for e-cigarettes or other tobacco products?
The original test was designed for cigarettes, but researchers have adapted versions for other nicotine products. E-cigarette users may find some questions less applicable, and interpretation should consider the different nicotine delivery profiles of various products.
Should I retake the test periodically?
Dependence levels can change over time with altered smoking patterns, stress levels, or previous quit attempts. Retaking the test during different life circumstances or before quit attempts can provide updated information for treatment planning.
What if my score seems inconsistent with my experience?
Individual experiences vary, and some people may feel more or less dependent than their score suggests. The test provides general guidance, but personal factors like genetics, mental health, and life circumstances significantly influence actual addiction experiences and cessation success.
Does a low score guarantee easy quitting?
While lower scores typically indicate less physical dependence and potentially easier cessation, psychological dependence, habits, and environmental factors still play significant roles. Even low-scoring individuals may face challenges and benefit from support and planning.
Medical Disclaimer
The Fagerström Test for Nicotine Dependence is a screening tool for educational and informational purposes only and should not replace professional medical assessment, diagnosis, or treatment. Test results provide general guidance about nicotine dependence levels but cannot predict individual cessation experiences or treatment outcomes. Always consult qualified healthcare providers for personalized medical advice, smoking cessation strategies, and treatment planning. Individual responses to nicotine addiction and cessation interventions vary significantly based on genetic, psychological, and environmental factors that require professional evaluation.