Fagerström Test for Nicotine Dependence (FTND)

How to Use This Calculator

1. Answer all 6 FTND questions about your smoking habits.
2. Score and dependence level appear instantly with NRT guidance.
3. HSI tab: rapid 2-item screen.
4. NRT Dosing tab: personalized patch and combination NRT recommendations.
5. Professional tier: full treatment plan with pharmacotherapy and behavioral support guidance.

Formula

Example

Frequently Asked Questions

• What is the Fagerström Test for Nicotine Dependence? ▼
  The Fagerström Test for Nicotine Dependence (FTND) is a standardized 6-item questionnaire that measures the intensity of physical nicotine addiction. It was originally developed by Karl-Olov Fagerström in 1978 as the Fagerström Tolerance Questionnaire (FTQ) and revised into its current 6-item form by Heatherton, Kozlowski, Frecker, and Fagerström in 1991. The FTND replaced the FTQ after research showed the revised version had better psychometric properties and more accurately reflected physical dependence. Scores range from 0 to 10. The two most heavily weighted items — time to first cigarette after waking (0–3 points) and cigarettes smoked per day (0–3 points) — together account for 6 of the 10 possible points, reflecting research showing these two factors are the strongest predictors of nicotine dependence and quit success. The FTND has been validated in numerous populations and languages and is the most widely used clinical and research tool for nicotine dependence assessment. It is specifically designed to measure physical rather than psychological nicotine dependence, which explains why it focuses on morning urges and total daily consumption rather than on psychological craving or smoking triggers.
• How do FTND scores guide treatment selection? ▼
  The FTND score directly informs pharmacotherapy intensity recommendations for smoking cessation. Scores of 0–2 (very low dependence) indicate minimal physical addiction; brief behavioral advice and low-dose nicotine replacement therapy (2 mg nicotine gum or lozenge) may be sufficient, though many patients at this level can quit with behavioral support alone. Scores of 3–4 (low dependence) warrant standard NRT — a 14 mg/24-hour nicotine patch or 2 mg gum used consistently for 8–12 weeks. Scores of 5–6 (moderate dependence) should prompt consideration of either combination NRT (patch plus short-acting form) or first-line pharmacotherapy with varenicline (Champix/Chantix), which triples cessation rates versus placebo. Scores of 7–8 (high dependence) strongly indicate varenicline as first-line therapy; combination NRT (21 mg patch plus 4 mg gum/lozenge) is an alternative if varenicline is contraindicated. Scores of 9–10 (very high dependence) require the most intensive approach: varenicline at full dose (1 mg twice daily after titration) combined with behavioral support; for heavy smokers unwilling to quit abruptly, a "cut and quit" strategy using NRT to reduce before stopping is an option. NICE guidance recommends offering pharmacotherapy to all smokers requesting cessation support regardless of FTND score.
• What is the Heaviness of Smoking Index (HSI) and how does it relate to FTND? ▼
  The Heaviness of Smoking Index (HSI) is a 2-item ultra-brief version of the FTND comprising only the two most predictive questions: time to first cigarette after waking (items 1, scored 0–3) and cigarettes smoked per day (scored 0–3), for a total range of 0–6. It was validated by Kozlowski and colleagues in 1994 and shown to be nearly as predictive of quit success as the full FTND in most populations, making it attractive for rapid clinical screening or epidemiological surveys. HSI scores of 0–1 are classified as low dependence, 2–3 moderate, and 4–6 high. The two-item screen correlates strongly (r ≈ 0.90) with the full FTND. For practical clinical purposes, the HSI can be used as a first-step triage: patients with HSI ≥ 4 should be offered pharmacotherapy without requiring the full FTND assessment. The remaining 4 FTND items add information about the breadth of dependence signs (inability to refrain in forbidden places, morning smoking preference, smoking throughout the day, smoking when ill) that may be useful for motivational counseling but add less incremental prediction to the core pharmacotherapy recommendation. In large-scale population surveys and clinical audit, the HSI is often preferred for its brevity.
• What pharmacotherapy options are available for nicotine dependence? ▼
  Three classes of pharmacotherapy have robust clinical trial evidence for nicotine dependence treatment. Nicotine Replacement Therapy (NRT) replaces the nicotine delivered by cigarettes without the carcinogenic combustion products. Available forms include patches (steady 24-hour delivery, 7/14/21 mg), gum (2/4 mg), lozenge (1.5/2/4 mg), inhaler, nasal spray, and sublingual tablet. Combination NRT (patch for steady-state plus short-acting form for breakthrough cravings) is more effective than monotherapy (NRT combination doubles odds of quitting versus no pharmacotherapy). Varenicline (Champix/Chantix) is a partial agonist at α4β2 nicotinic acetylcholine receptors — it reduces withdrawal symptoms by partially activating the receptor and blocks the reinforcing effects of nicotine by competitive occupation. Meta-analyses show varenicline has the highest efficacy of any single agent (OR 2.8–3.1 versus placebo). Psychiatric safety concerns raised in 2008 were largely resolved by the EAGLES trial (2016, 8,144 participants) which showed no excess neuropsychiatric adverse events in smokers with or without psychiatric disorders. Bupropion (Zyban/Wellbutrin) is a norepinephrine-dopamine reuptake inhibitor that reduces withdrawal and craving; it approximately doubles quit rates versus placebo and is useful when varenicline is contraindicated. All three are recommended in combination with behavioral support for maximum efficacy.
• How many quit attempts does it typically take to quit smoking permanently? ▼
  Nicotine dependence is a chronic relapsing condition, and multiple quit attempts are the norm rather than the exception. A widely cited analysis by Chaiton and colleagues (2016) in the BMJ Open found that the median number of attempts before successfully quitting for one year was approximately 30 attempts, with a range suggesting many smokers require 6 months to multiple years of trying. Earlier research by West and colleagues (2001) found that in a given year approximately 40% of smokers attempt to quit but only 3–5% achieve sustained abstinence at 12 months without pharmacological aid. With best-practice combination treatment (pharmacotherapy + intensive behavioral support), 12-month abstinence rates reach 20–30%. The concept of "unsuccessful" attempts is misleading — each quit attempt provides information about triggers and barriers, and many smokers maintain prolonged periods of abstinence before full cessation. The 5As framework used in clinical practice (Ask, Advise, Assess readiness, Assist, Arrange follow-up) recognizes the cyclical nature of behavior change and recommends non-judgmental support for relapse rather than labeling it as failure. FTND scores that increase over time may reflect escalating dependence and should prompt more intensive treatment approaches.

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