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Fagerström Test For Nicotine Dependence (Ftnd) Calculator

Score your nicotine dependence with the validated 6-question FTND scale (0–10) and receive evidence-based cessation guidance.

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Inputs

How soon after waking do you smoke your first cigarette?

Do you find it difficult to refrain from smoking in places where it is forbidden?

Which cigarette would you hate most to give up?

How many cigarettes per day do you smoke?

Do you smoke more frequently during the first hours after waking than during the rest of the day?

Do you smoke if you are so ill that you are in bed most of the day?

FTND Score (Nicotine Dependence)

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Get a plain-English breakdown of your result with practical next steps.

FTND Score (Nicotine Dependence)—points

The formula

How the
result is
computed.

What Is the Fagerström Test for Nicotine Dependence?

The Fagerström Test for Nicotine Dependence (FTND) is a standardized six-item questionnaire that quantifies the intensity of physical addiction to nicotine in cigarette smokers. Originally derived from the Fagerström Tolerance Questionnaire by Karl-Olov Fagerström, the revised instrument produces a total score between 0 and 10. Clinicians, researchers, and public health professionals worldwide use FTND results to stratify dependence severity and tailor cessation interventions accordingly.

The FTND Scoring Formula

The total score is computed as the simple sum of all six item responses:

FTND = Q1 + Q2 + Q3 + Q4 + Q5 + Q6

Each question (Q_i) contributes 0, 1, 2, or 3 points depending on the selected response. The maximum achievable total is 10 points.

Question-by-Question Scoring Breakdown

Time to first cigarette after waking (Q1 — up to 3 pts): Smoking within 5 minutes earns 3 points; 6–30 minutes earns 2; 31–60 minutes earns 1; more than 60 minutes earns 0. This single item is the strongest individual predictor of dependence severity.
Difficulty refraining in smoke-free areas (Q2 — up to 1 pt): Selecting Yes scores 1 point; No scores 0.
Cigarette most hated to give up (Q3 — up to 1 pt): Identifying the first morning cigarette scores 1 point; any other cigarette scores 0.
Average daily cigarette consumption (Q4 — up to 3 pts): Ten or fewer cigarettes scores 0; 11–20 scores 1; 21–30 scores 2; 31 or more scores 3.
Heavier morning smoking pattern (Q5 — up to 1 pt): Yes scores 1 point; No scores 0.
Smoking while confined to bed with illness (Q6 — up to 1 pt): Yes scores 1 point; No scores 0.

Interpreting the Total FTND Score

Once all six responses are summed, the total score places the smoker into one of five dependence categories:

0–2 — Very Low Dependence: Minimal physical reliance on nicotine. Behavioral counseling alone is often sufficient for cessation.
3–4 — Low Dependence: Some physical reliance. Brief structured counseling and behavioral strategies are recommended.
5 — Medium Dependence: Moderate addiction. Nicotine replacement therapy (NRT) alongside behavioral support is strongly advised.
6–7 — High Dependence: Strong physical addiction. Combination pharmacotherapy — such as NRT plus bupropion or varenicline — yields better outcomes.
8–10 — Very High Dependence: Severe addiction. Intensive programs combining long-course pharmacotherapy with multi-session behavioral counseling offer the best quit rates.

Clinical Significance and Research Foundation

The FTND is the most extensively validated brief measure of cigarette dependence available. According to the Penn State Center for Research on Tobacco and Health, the instrument demonstrates strong test-retest reliability and predictive validity for cessation outcomes across diverse populations. A peer-reviewed study published on PubMed Central examining lottery-based workplace cessation programs confirms that baseline FTND scores consistently predict quit difficulty and appropriately guide pharmacotherapy selection. Additionally, the FTND Scoring Table in the Statistical Analysis Plan for NCT01967732 specifies the exact response-to-point mappings used in regulated clinical trial settings, confirming the scoring rubric employed by this calculator.

The two most heavily weighted items — time to first cigarette (max 3 pts) and daily cigarette count (max 3 pts) — together account for up to 6 of the 10 possible points. This weighting reflects the biological reality that early-morning craving intensity and total daily nicotine intake are the strongest markers of physical dependence.

Worked Example

A smoker who lights up 10 minutes after waking scores 2 points (6–30 min bracket). Difficulty refraining in smoke-free areas adds 1 point. Identifying the morning cigarette as the one most hated to give up adds 1 more. Smoking 25 cigarettes daily scores 2 points (21–30 bracket). Smoking more heavily in the first morning hour scores 1 point. Continuing to smoke even while bedridden with illness scores the final 1 point. The total FTND score is 2 + 1 + 1 + 2 + 1 + 1 = 8 — very high dependence — making this individual a strong candidate for combination pharmacotherapy.

Limitations and Complementary Tools

The FTND measures physical nicotine dependence exclusively and does not capture psychological or behavioral smoking drivers such as stress-triggered cravings, social smoking cues, or emotional regulation. Clinicians typically pair FTND results with readiness-to-quit assessments and motivation scales for a complete dependence profile. The instrument was validated for cigarette smokers; adapted scoring systems exist for cigar, pipe, and smokeless tobacco products.

Reference

Frequently asked questions

What does the Fagerström Test for Nicotine Dependence measure?

The Fagerström Test for Nicotine Dependence measures the degree of physical addiction to nicotine in cigarette smokers. Six scored questions cover morning craving urgency, daily consumption, and behavior under restricted or illness conditions. The resulting 0–10 score stratifies smokers from very low dependence (0–2) to very high dependence (8–10), directly informing which cessation strategies are most likely to succeed.

What is considered a high score on the Fagerström test?

A score of 6 or above indicates high to very high nicotine dependence on the FTND scale. Scores of 6–7 fall into the high-dependence band, and scores of 8–10 indicate very high dependence. Smokers in these ranges typically experience intense withdrawal symptoms within hours of their last cigarette and achieve significantly better quit rates when prescribed combination pharmacotherapy — such as varenicline plus nicotine replacement — alongside intensive behavioral counseling.

Which FTND question carries the most weight in the final score?

The question about time to first cigarette after waking carries the most weight, contributing up to 3 of the 10 possible points. Scoring 3 points requires smoking within just 5 minutes of waking, which signals severe overnight nicotine depletion and a powerful physical craving cycle. Research consistently identifies this early-morning urgency as the strongest single predictor of overall dependence severity and future quit difficulty among all six FTND items.

How is the FTND calculator score calculated step by step?

Each of the six FTND questions is assigned a point value based on the selected response — between 0 and 3 points per question — and all six values are added together for the final score. For example, a smoker who scores 3 (first cigarette within 5 minutes) + 1 (difficulty refraining) + 1 (morning cigarette most valued) + 3 (31+ cigarettes daily) + 1 (heavier morning smoking) + 1 (smokes when ill) achieves a total FTND score of 10, the maximum possible, indicating the most severe dependence category.

Can the Fagerström test be used to assess e-cigarette or vaping dependence?

The standard FTND was developed and validated exclusively for cigarette smokers, so its scoring thresholds do not directly translate to e-cigarette or vaping users. While core concepts such as morning craving urgency and daily consumption frequency remain relevant, the specific point cutoffs reflect cigarette pharmacokinetics. Healthcare providers assessing nicotine dependence in vaping populations may find instruments specifically validated for nicotine product categories — such as adapted e-cigarette dependence measures — more clinically appropriate.

What cessation treatments are recommended based on FTND scores?

Treatment intensity scales with FTND score. Very low scorers (0–2) often succeed with self-help materials and brief behavioral counseling. Low scorers (3–4) benefit from structured brief counseling sessions. Medium scorers (score of 5) should seriously consider nicotine replacement therapy such as patches or gum. High scorers (6–7) and very high scorers (8–10) have the strongest evidence base for combination pharmacotherapy — pairing a prescription medication like varenicline or bupropion with NRT — alongside multi-session behavioral support programs to maximize quit rates.