Screening tools

The Fagerström test — how nicotine dependence is measured

Updated 2026-07-11 · Grounded in: Heatherton et al. 1991 (FTND) · Fagerström 1978 · Fagerström 2012 (renaming note)

The Fagerström test — formally the Fagerström Test for Nicotine Dependence, FTND — is a six-question screen that measures how strong a nicotine dependence is. It grew out of Karl-Olov Fagerström's original questionnaire from 1978 and was refined into its current six-question form in 1991. It remains the standard dependence measure in smoking research and cessation clinics worldwide; its authors later renamed it the Fagerström Test for Cigarette Dependence.

The key idea behind it: dependence shows less in how much you smoke and more in the pattern around it — especially how soon after waking the first cigarette happens.

What the six questions cover

The questions ask: how soon after waking you smoke your first cigarette, whether it's hard not to smoke in no-smoking places, which cigarette you'd hate most to give up, how many you smoke per day, whether you smoke more in the first hours after waking, and whether you smoke even when ill in bed.

The two heaviest-weighted questions are time-to-first-cigarette and cigarettes per day. Time to first cigarette is the single strongest indicator in the test — smoking within the first half hour of waking says more about dependence than most other answers combined.

How the scoring is generally read

The test runs from 0 to 10. Lower scores are generally read as low dependence, a middle range as moderate, and higher scores as high dependence — where the body is more involved, quitting cold turkey tends to be harder, and support like nicotine replacement (discussed with a pharmacist or doctor) meaningfully improves the odds.

A low score doesn't mean quitting will be easy — habit and context have their own grip beyond chemistry. It means the physical-dependence part of the picture is lighter.

Honest limits

A screening tool estimates how risky a pattern looks — it cannot diagnose anyone. Only a qualified clinician can do that, with a real conversation.
Scores describe the recent past you reported. They don't define you, and they change when the pattern changes.
An honest result needs honest answers, and it's normal for the first attempt to soften things. The tool works best as a private conversation with yourself.

Take it privately — no name, no account

The free check-in uses the real, validated questions described above. About three minutes, a plain-words result, and a first step that fits it — including an honest pointer to professional care when that's the right answer.

Start the free check-in

Common questions

Is the Fagerström test a diagnosis?

No — it's a measure of how strong nicotine dependence looks, used to gauge what kind of support fits. Diagnosis and treatment decisions belong to clinicians. The score is a starting point, not a label.

Does it work for vaping?

The original test was written for cigarettes. Adapted versions exist for e-cigarettes, and the core signal — how soon after waking, and how hard it is to go without — reads the same way. The check-in here covers smoking and vaping together.

Why does the first cigarette of the day matter so much?

Overnight, nicotine leaves the body. How urgently it gets replaced in the morning is the cleanest window into how dependent the body has become — cleaner than daily count, which lifestyle can mask.

What does my score change in practice?

In cessation care, higher dependence usually means support — like nicotine replacement or medication discussed with a doctor or pharmacist — makes a real difference, while lighter dependence often responds well to a plan around habits and triggers. Either way, a plan beats willpower alone.

Can I take it online for free?

Yes — the free check-in uses the real Fagerström questions, takes about three minutes, and is private: no name and no account needed to see where you stand.

Who was Fagerström?

Karl-Olov Fagerström is a Swedish clinical psychologist who built the original questionnaire in 1978. The 1991 six-question revision he co-authored with researchers Heatherton, Kozlowski and Frecker became the worldwide standard.

The Mansio is a private wellness, education, and behaviour-change support tool. It is not a medical device, not therapy, and not a substitute for professional medical or mental-health care. If you're in crisis, call your local emergency number — crisis help is always free and never requires an account.