The Fagerström Test for Nicotine Dependence is a brief, six-item questionnaire that scores how physically dependent a smoker is on nicotine, from 0 (minimal) to 10 (severe). Developed in 1991 as a revision of the earlier Fagerström Tolerance Questionnaire, it remains the most widely used screening tool of its kind in both research and clinical practice. This article explains how the score is built, how to read it, and where its limits lie.
How the FTND score works
Six items are each graded per the published scale and summed. Two items — how soon after waking the first cigarette is smoked, and how many cigarettes are smoked per day — carry the most weight, each scoring 0 to 3 points. The other four items (difficulty refraining in forbidden places, the cigarette hated most to give up, smoking more in the morning, and smoking even when ill) each score 0 or 1 point.
That weighting is deliberate: time to first cigarette and cigarettes per day are the strongest single predictors of dependence and biochemical markers of nicotine exposure in the validation research behind the scale, so they contribute more to the 0–10 total than the other four items.
Reading the score and dependence tier
The total maps to five bands: 0–2 very low, 3–4 low, 5 medium, 6–7 high, and 8–10 very high dependence. Higher totals are associated with more intense withdrawal symptoms on quitting and a lower likelihood of success without pharmacological support, and can help inform the starting intensity of nicotine replacement therapy or the choice of combination treatment.
Time to first cigarette alone is often used as a quick, single-question proxy for dependence — someone who lights up within 5 minutes of waking is considered highly dependent even before the other five questions are answered.
Limits and how it should be used
The FTND measures physical dependence on nicotine; it does not diagnose tobacco use disorder on its own, which typically also weighs behavioral and psychological criteria (e.g. the DSM-5 criteria for substance use disorders). It is a self-report tool, so answers depend on the smoker's honesty and self-awareness, and it does not capture vaping, smokeless tobacco, or dual use patterns.
This calculator is for education and clinical reference only. Any decision about cessation treatment, nicotine replacement therapy dosing, or combination pharmacotherapy should be made together with a healthcare provider based on the smoker's complete history.