Fagerstrom Test For Nicotine Dependence - Score the Six FTND Items

The fagerstrom test for nicotine dependence is the six-item questionnaire that Heatherton, Kozlowski, Frecker, and Fagerstrom published in 1991 to measure physical dependence on cigarettes. Each item is scored from a fixed choice set, the total ranges from 0 to 10, and the result is read against the five dependence bands.

• • Self check before a quit attempt: take the six items in a quiet moment so the conversation with a clinician or quitline starts with a shared number.
• • Research and trial screening: use the same Heatherton 1991 wording to compare a participant's score with the published FTND literature.
• • Cessation program intake: score a participant at intake to plan nicotine-replacement dosing or behavioral support based on dependence severity.
• • Re-screening after a behavior change: repeat the FTND after a quit attempt or step-down to track how the dependence pattern has shifted.

The form is short on purpose. Two items use a 0 to 3 ladder and four items use a 0 to 1 yes-or-no response. The total is the simple sum of the six per-item scores.

The test is a screening tool, not a clinical diagnosis. A high total is a reason to talk with a clinician or a quitline, not a label.

A shorter two-item screen built from the same FTND items is the HSI Calculator, which totals the time to first cigarette and cigarettes per day items into a 0 to 6 dependence band.

The fagerstrom test for nicotine dependence works in two steps. The calculator adds the six per-item scores to a 0-10 total, then applies the Heatherton 1991 five-band dependence label.

• q1TimeToFirst: Q1 score: 0 = After 60 min, 1 = 31-60 min, 2 = 5-30 min, 3 = Within 5 min.
• q2ForbiddenPlace: Q2 score: 0 = No, 1 = Yes; hard to refrain in forbidden places.
• q3FirstMorning: Q3 score: 0 = All others, 1 = The first one in the morning; the most hated cigarette.
• q4CigarettesPerDay: Q4 score: 0 = 10 or fewer, 1 = 11-20, 2 = 21-30, 3 = 31 or more.
• q5MorningMoreFrequent: Q5 score: 0 = No, 1 = Yes; smoking more in the first hours after waking.
• q6SmokeWhenIll: Q6 score: 0 = No, 1 = Yes; smoking even when bedbound with illness.

The result panel shows the per-item scores alongside the total and the dependence band. Time to first cigarette and cigarettes per day can each contribute up to 3 points, and the four yes-or-no items can each contribute 1 point.

The band is read against the inclusive ranges Heatherton and colleagues used in 1991. The calculator applies the band automatically.

According to Heatherton et al. 1991 (PubMed), the Fagerstrom Test for Nicotine Dependence has six items, totals 0 to 10, and labels dependence as very low (0-2), low (3-4), medium (5), high (6-7), or very high (8-10).

When a high FTND total points toward a quit attempt, the Smoking Recovery Calculator can estimate how a planned stop date maps to recovery milestones.

Four concepts matter for reading the fagerstrom test for nicotine dependence the way Heatherton and colleagues designed it.

Time to first cigarette is the most informative item in the original paper. A first cigarette within 5 minutes of waking is the most heavily weighted response.

The bands are population-level descriptors, not personal thresholds. The tool reports the band but leaves the next step to the reader and their clinician.

The FTND follows the same per-item-and-total screening pattern used in the Audit C Calculator, which totals three WHO alcohol consumption questions against a sex-specific positive cutoff.

The form is six short questions, each answered with a fixed choice set. Answer the questions for a typical recent week, not for an unusually heavy day or a recent quit attempt.

1. 1 Pick the time to first cigarette: select the response that best matches how soon you smoke after waking, from After 60 min (0) to Within 5 min (3).
2. 2 Answer the forbidden place question: select Yes (1) or No (0) for whether you find it hard to refrain in places where smoking is forbidden.
3. 3 Pick the most hated cigarette: select the first one in the morning (1) or all others (0) for the cigarette you would hate most to give up.
4. 4 Pick the cigarettes per day band: select the band that matches a typical day, from 10 or fewer (0) up to 31 or more (3).
5. 5 Answer the morning frequency question: select Yes (1) or No (0) for smoking more in the first hours after waking.
6. 6 Answer the illness smoking question: select Yes (1) or No (0) for smoking even when you are so ill you are in bed, then read the total and band.

A reader who smokes within 5 minutes of waking, has 21-30 cigarettes per day, says yes to forbidden places, the morning cigarette is the hardest to give up, and yes to morning frequency enters Q1 = 3, Q2 = 1, Q3 = 1, Q4 = 2, Q5 = 1, Q6 = 0. The total is 8 and the band is very high dependence.

After taking the FTND, the Quit Smoking Calculator estimates the money saved, life-years gained, and health milestones that a planned quit date can produce.

Using the fagerstrom test for nicotine dependence the way Heatherton and colleagues designed it gives practical benefits over a single yes-or-no question about smoking.

• • Validated six-item wording: the test uses the original 1991 Heatherton wording, so the score can be compared with the published FTND literature.
• • Per-item and total readout: the result panel shows the six per-item scores alongside the 0 to 10 total so the reader can see which behaviors drive the result.
• • Five dependence bands: the Heatherton 1991 five-band label is applied automatically and matches what primary care, quitlines, and research use.
• • Plain language help text: each dropdown has a short note so the reader can match the response to a typical recent week, not an unusually heavy day.
• • Screening-not-diagnosis framing: the result is framed as a brief screen, not a clinical diagnosis of tobacco use disorder.
• • Re-screening friendly: the same wording and scoring can be used before and after a quit attempt, a step-down, or a behavior change.

The FTND pairs well with a shorter screen or a fuller assessment. The two-item HSI uses a subset of the FTND items and is often used as a quick re-screening tool.

The FTND pairs well with other brief substance-screening tools, and the CAGE Questionnaire Calculator applies the same per-item yes-or-no pattern to flag possible alcohol problems in a primary-care visit.

The result depends on the answers entered and on the band cutoffs Heatherton and colleagues published in 1991. Small changes can flip the band near the band edges.

• • The fagerstrom test for nicotine dependence is a brief screen, not a clinical diagnosis. A high total is a reason to discuss cessation support with a clinician, not a label of tobacco use disorder.
• • The FTND was developed for cigarette smokers. E-cigarettes, smokeless tobacco, and pipe or cigar smoking are not the same product, and the published cutoffs were not validated for those products.
• • Self-reported smoking is known to be biased low, and the FTND does not correct for that. Comparing the score with biomarkers such as cotinine is the usual next step.

The band label is read against the Heatherton 1991 reference ranges, not a personal quit goal. A medium or higher total is a reasonable trigger for a clinical conversation or quitline referral.

A very high total points toward a fuller assessment and evidence-based cessation support. Counseling, nicotine-replacement therapy, or prescription options are typical next steps.

According to CDC cigarettes and cancer overview, cigarette smoking is the leading cause of preventable disease and death in the United States, and nicotine is the addictive drug in tobacco that makes quitting difficult.

According to NIDA tobacco and nicotine research topic, nicotine activates reward pathways in the brain and produces dependence, and structured screening tools such as the FTND help measure dependence severity in research and treatment settings.

A very high FTND total often overlaps with disrupted sleep, and the Epworth Sleepiness Scale Calculator applies a similar eight-item per-item-and-total pattern to flag daytime sleepiness that may deserve a clinical conversation.