Fagerström Test for Nicotine Dependence (FTND score)

Understanding the Fagerström test for nicotine dependence — concept and principle

The Fagerström Test for Nicotine Dependence (FTND) is a six-question score of how physically dependent a person is on cigarettes. Smokers use it to understand their habit, and stop-smoking services use it to plan support and the strength of nicotine replacement.

Six questions add up: with the default inputs the result is FTND 4 (low to moderate · HSI 3).

How it is calculated

FTND score = sum of six answers (0–10)

Time to first cigarette after waking: within 5 min = 3, 6–30 min = 2, 31–60 min = 1, later = 0.
Cigarettes per day: 10 or fewer = 0, 11–20 = 1, 21–30 = 2, 31 or more = 3.
Three yes/no questions score 1 for yes: hard to refrain in no-smoking places, smoking more in the morning, smoking when ill in bed. The question on which cigarette you would hate most to give up scores 1 for the first one of the morning.

Bands: 0–2 low, 3–4 low to moderate, 5–7 moderate, 8–10 high dependence.

Heaviness of Smoking Index (HSI) = time to first cigarette + cigarettes per day (0–6).

The principle

Nicotine levels fall overnight, so a dependent smoker feels the strongest need soon after waking. That is why time to the first cigarette carries up to 3 points and the morning cigarette is valued most. Daily cigarette count reflects how much nicotine the body is used to. The HSI keeps only these two strongest items and works almost as well as the full test.

Worked example

Default answers: first cigarette 6–30 min (2), no difficulty in no-smoking places (0), first morning cigarette hardest to give up (1), 11–20 a day (1), not more in the morning (0), not when ill (0).

FTND = 2 + 0 + 1 + 1 + 0 + 0 = 4 → low to moderate dependence.
HSI = 2 + 1 = 3.

How to read the result

Where does your result fall?

Higher scores mean stronger physical dependence and usually more withdrawal symptoms when stopping. Higher-scoring smokers often benefit from combination nicotine replacement or medicines, plus behavioural support. The score does not measure motivation or predict exactly how hard quitting will be.

Common mistakes

Counting e-cigarette puffs as cigarettes. The test was designed for cigarettes.
Answering about an unusual day rather than a typical one.
Treating a low score as a reason not to seek help.

Keep in mind: This is a self-assessment, not a diagnosis. For help stopping smoking, talk to a doctor, pharmacist or a stop-smoking service.

Frequently asked questions

What is a high Fagerström score?

8 to 10 points is high dependence.

What is the Heaviness of Smoking Index used for?

It is a quick two-question version used in busy clinics and surveys.

Can the score fall over time?

Yes. Cutting down or quitting lowers it, and it can be repeated to track change.

Sources: Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO, "The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire", Br J Addict 1991;86:1119–1127 · Heatherton TF et al., "Measuring the heaviness of smoking", Br J Addict 1989;84:791–799

Checked 9 Nov 2026. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 1991;86:1119–1127; score bands as used in the HSE (Ireland) clinical form; Heaviness of Smoking Index: Heatherton et al., Br J Addict 1989;84:791–799.

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