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What Is the Fagerström Test for Nicotine Dependence (FTND)? A Complete Guide

QuitbookSeptember 18, 20268 min read

The Fagerström Test for Nicotine Dependence (FTND) is a validated 6-question clinical questionnaire used by healthcare providers worldwide to measure the severity of a person's physical addiction to nicotine. It takes about two minutes to complete, produces a score from 0 to 10, and that score is one of the most useful pieces of information you can have before choosing how to quit — because the right quitting strategy depends heavily on how physically dependent you actually are.

Where the FTND Comes From

The test was developed by Swedish researcher Karl Fagerström in 1978 as the Fagerström Tolerance Questionnaire, then revised and shortened in 1991 by Thomas Heatherton, Fagerström, and colleagues into the six-item Fagerström Test for Nicotine Dependence used today. It has since become the most widely used self-report measure of nicotine dependence in both clinical practice and smoking-cessation research, precisely because it is short, easy to self-administer, and correlates well with biological markers of dependence such as cotinine levels and time to relapse.

The 6 FTND Questions

Each question is scored, and the points are added together for a total out of 10.

#	Question	Answer	Points
1	How soon after you wake up do you smoke your first cigarette?	Within 5 minutes	3
		6–30 minutes	2
		31–60 minutes	1
		After 60 minutes	0
2	Do you find it difficult to refrain from smoking in places where it is forbidden?	Yes	1
		No	0
3	Which cigarette would you hate most to give up?	The first one in the morning	1
		Any other	0
4	How many cigarettes per day do you smoke?	10 or fewer	0
		11–20	1
		21–30	2
		31 or more	3
5	Do you smoke more frequently during the first hours after waking than during the rest of the day?	Yes	1
		No	0
6	Do you smoke even if you are so ill that you are in bed most of the day?	Yes	1
		No	0

How to Score the FTND

Total score	Dependence level
0–2	Very low dependence
3–4	Low dependence
5	Moderate dependence
6–7	High dependence
8–10	Very high dependence

Why the First Cigarette Question Matters Most

Question 1 — how soon after waking you smoke your first cigarette — is the single most predictive item in the test and is weighted accordingly (up to 3 points, the maximum of any question). Smoking within 5 minutes of waking indicates that nicotine has fallen to a level overnight low enough to trigger a strong physiological craving before you've even had coffee — a marker of significant physical dependence that correlates strongly with withdrawal severity and relapse risk. If you remember only one question from the FTND, this is the one worth answering honestly.

What Your FTND Score Means for Quitting

Your FTND score isn't just a label — it should shape your quitting strategy:

Very low to low (0–4): Physical dependence is mild enough that abrupt cessation ("cold turkey") has a reasonable chance of success without pharmacological support, though behavioral tools still help with the psychological habit.
Moderate (5): A combination approach — nicotine replacement therapy (NRT) or medication plus behavioral support — is often recommended.
High to very high (6–10): Abrupt cessation carries a meaningfully higher relapse risk. A gradual reduction plan, NRT, and/or prescription cessation medication, alongside structured behavioral support, is typically more effective than quitting cold turkey.

This is precisely why a nicotine assessment before setting a quit date matters: two people who both "smoke a pack a day" can have very different FTND scores and very different withdrawal experiences depending on smoking pattern, and treating them identically ignores that difference. For a deeper look at how to choose between the two approaches, see How to Quit Smoking: Cold Turkey vs. Gradual & More.

Limitations of the FTND

The FTND measures physical, nicotine-driven dependence — it does not capture the psychological and behavioral side of smoking: habit loops tied to specific triggers, stress-coping associations, or social smoking patterns. Two smokers with identical FTND scores can have very different relapse risks depending on those behavioral factors, which is why the FTND is best used alongside — not instead of — cognitive and behavioral tools that address the habit itself, such as CBT-based thought journaling and trigger mapping. The test was also designed and validated for cigarette smoking specifically; its scoring does not map cleanly onto vaping or other nicotine delivery methods, though several adapted versions exist for that purpose.

How QuitBook Uses the FTND

QuitBook's onboarding is FTND-inspired rather than a literal administration of the full 6-question clinical instrument. It asks four questions drawn from the same clinical logic — time to first cigarette, daily cigarette count, how hard it would be to go without smoking, and which cigarette would be hardest to give up — and combines them into an internal dependence score. That score isn't shown to you as a number or labeled "Fagerström"; it's used behind the scenes to personalize your plan, including whether a gradual reduction phase is suggested before your quit date and how the app calibrates its craving-management tools to your dependence level. It's a lighter-touch, personalization-focused adaptation of the FTND rather than a clinical diagnostic administered and scored for the user to see.

Frequently Asked Questions

Is the Fagerström Test accurate?

The FTND is one of the most validated self-report measures of nicotine dependence available, with decades of research correlating its scores with biological markers (like cotinine levels) and real-world outcomes (like relapse rates and withdrawal severity). Like any self-report tool, its accuracy depends on honest answers, but it remains the standard instrument used by healthcare providers and researchers.

What's a "good" FTND score?

There's no "good" or "bad" score — it's a measurement, not a judgment. A lower score (0–4) generally means physical withdrawal will be milder if you quit abruptly; a higher score (6–10) means you may benefit more from gradual reduction, NRT, or medication alongside behavioral support.

Is the FTND used for vaping too?

The original FTND was designed and validated for cigarette smoking. Several adapted versions exist for e-cigarette use, but the standard 6-question FTND described here does not map precisely onto vaping patterns.

Can I retake the FTND after I've reduced my smoking?

Yes. Since the FTND measures current physical dependence, your score can change as your smoking pattern changes — for example, during a gradual reduction program. Retaking it periodically can help track whether your dependence is easing.

Does QuitBook use the Fagerström Test?

QuitBook's onboarding uses an FTND-inspired assessment — not the literal 6-question clinical instrument — to personalize your plan. It asks four dependence-related questions, computes an internal score, and uses that score (never shown to you directly) to shape recommendations like whether gradual reduction fits your dependence level.

Conclusion

The Fagerström Test for Nicotine Dependence takes two minutes and answers a question most people never actually ask before trying to quit: how physically dependent am I, really? That answer should determine whether cold turkey, gradual reduction, NRT, or medication is the right starting point — because the strategy that works for a light smoker can set up a heavy smoker to relapse, and vice versa.

QuitBook's onboarding uses an FTND-inspired assessment to personalize your plan before you set a quit date. See it in the app →

Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult a qualified healthcare provider before beginning a smoking cessation program.

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