You answered six questions about your smoking habits and got a score between 0 and 10. The Fagerstrom Test for Nicotine Dependence (FTND) is the most widely used tool for measuring physical addiction to cigarettes. It helps predict how hard quitting might be and what kind of help you'll likely need. Here's what your score means.
The quick answer
| Score | Dependence level | What it means for quitting |
|---|---|---|
| 0-2 | Low | Willpower and behavioral strategies may be enough |
| 3-4 | Low to moderate | Nicotine replacement therapy (NRT) could help |
| 5-7 | Moderate | Medication strongly recommended |
| 8-10 | High | Intensive treatment with combination therapy advised |
The key threshold is 5. If you scored 5 or higher, your body has developed significant physical dependence on nicotine, and quitting without medication is substantially harder.
What your score tells you
Score 0-2: Low dependence
Your smoking is more habit than physical addiction. This doesn't mean quitting will be easy (habits are powerful), but your body isn't as dependent on nicotine as heavier smokers. You may be able to quit using:
- Behavioral strategies (identifying triggers, breaking routines)
- Quitline support or counseling
- Self-help resources and apps
- NRT if cravings become difficult
Many light smokers succeed without medication, though NRT can still help.
Score 3-4: Low to moderate dependence
You have some physical dependence, but it's manageable. Consider combining behavioral support with nicotine replacement:
- Nicotine patches, gum, or lozenges (available over-the-counter)
- Quitline counseling (1-800-QUIT-NOW)
- Apps or online programs for tracking and support
The patch alone or a short-acting form (gum, lozenge, inhaler) is typically sufficient at this level.
Score 5-7: Moderate dependence
This is where quitting gets significantly harder without help. At this level, your body expects regular nicotine doses, and withdrawal symptoms will be noticeable. Medication is strongly supported by research:
- Combination NRT: Patch plus a short-acting form (gum, lozenge, or inhaler)
- Varenicline (Chantix): Prescription medication that reduces cravings and blocks nicotine's rewarding effects
- Bupropion (Wellbutrin/Zyban): Prescription option that also helps with mood
Talk to your doctor. With appropriate medication and support, quit rates improve substantially.
Score 8-10: High dependence
You have significant physical addiction to nicotine. Quitting "cold turkey" is very difficult at this level, not because you lack willpower, but because your brain chemistry has adapted to regular nicotine. Intensive treatment is recommended:
- Higher-dose NRT or combination approaches
- Varenicline (often the most effective single medication for high dependence)
- Combination of varenicline plus NRT in some cases
- More frequent counseling contacts
- Longer treatment duration (12+ weeks rather than 8)
Don't be discouraged by this score. It simply means you need more support, and effective support exists.
The six questions explained
Question 1: "How soon after you wake up do you smoke your first cigarette?"
This is the strongest predictor of dependence. Smoking within 5 minutes of waking (3 points) indicates your body depletes nicotine overnight and urgently needs replenishment. The sooner you smoke, the more dependent you are.
The science: During sleep, nicotine levels drop. How quickly you need to restore them reflects how much your body relies on the drug. People who can wait an hour or more have less physiological urgency.
Question 2: "Do you find it difficult to refrain from smoking in places where it is forbidden?"
This measures compulsion, whether smoking has become something you feel driven to do regardless of context. Difficulty refraining in smoke-free areas suggests smoking is no longer just a choice.
Question 3: "Which cigarette would you hate most to give up?"
If the first cigarette of the day is hardest to give up (1 point), it confirms the morning-urgency pattern. This cigarette relieves overnight withdrawal, making it feel especially necessary.
Question 4: "How many cigarettes per day do you smoke?"
More cigarettes means more nicotine exposure, more adaptation, and higher dependence. Smoking 31+ cigarettes daily (3 points) indicates your body has adjusted to high nicotine levels.
Context matters here. This question correlates with dependence but isn't the whole story. Some people smoke fewer cigarettes but inhale more deeply; others smoke many but don't inhale much.
Question 5: "Do you smoke more frequently in the first hours after waking?"
Front-loaded smoking, where you smoke more heavily in the morning, indicates withdrawal-driven behavior. Your body is most depleted after sleep, so dependent smokers compensate by smoking more in the morning.
Question 6: "Do you smoke if you are so ill that you are in bed most of the day?"
Smoking when sick shows compulsive use. Despite feeling terrible and having obvious reasons not to smoke, you still do. This reflects dependence overriding normal judgment.
Common patterns
"Morning person" (high scores on questions 1, 3, 5)
Your dependence centers on nicotine depletion and restoration cycles. You'll likely experience the strongest cravings in the morning. Treatment tip: Consider using long-acting NRT (patch) to maintain steady nicotine levels, especially overnight.
"Heavy smoker" (high scores on questions 2, 4, 6)
Your dependence reflects high consumption and compulsive patterns. You may smoke almost automatically throughout the day. Treatment tip: Higher doses of NRT or prescription medications are often needed.
"Both patterns" (high scores across all questions)
You have both strong physical dependence and high consumption. This typically means the highest scores (8-10). Treatment tip: Combination therapy and intensive support offer the best outcomes.
What the FTND doesn't measure
Psychological dependence. The FTND focuses on physical addiction, not the psychological role smoking plays in your life (stress relief, social connection, identity). You might score low but still find quitting hard because smoking is deeply tied to how you cope.
E-cigarettes and other nicotine products. The FTND was designed for cigarette smokers. If you vape, use smokeless tobacco, or combine products, the questions don't translate directly.
Your motivation to quit. Dependence level doesn't predict motivation. Someone highly dependent who truly wants to quit may succeed where a less dependent but unmotivated smoker doesn't.
Previous quit attempts. The FTND doesn't ask about your history. Past attempts provide useful information about what has and hasn't worked for you.
Why your FTND score matters for treatment
Matching treatment intensity to dependence level improves outcomes:
A highly dependent smoker trying to quit with willpower alone faces a steep challenge. Their brain chemistry is working against them. Appropriate medication makes the difference between a realistic and near-impossible quit attempt.
On the other hand, a lightly dependent smoker doesn't necessarily need prescription medication. Behavioral strategies may be enough, and medication costs money with potential side effects.
Your FTND score helps calibrate the right level of support.
Talking to your doctor
If you're planning a quit attempt, sharing your FTND score with your healthcare provider helps them recommend appropriate treatment. Key discussion points:
- Your score and what it suggests about treatment intensity
- Previous quit attempts and what made them difficult
- Medication options (NRT, varenicline, bupropion)
- Counseling and support resources
- Quit date planning
Providers who understand your dependence level can tailor recommendations rather than offering one-size-fits-all advice.
If you want to quit
Regardless of your FTND score, effective help exists:
- 1-800-QUIT-NOW: Free phone counseling available in all US states
- Smokefree.gov: Resources, tools, and text programs
- Your healthcare provider: Can prescribe medications and provide guidance
- Community health centers: Often offer cessation programs
Higher dependence scores mean you need more support, not that quitting is impossible. With appropriate treatment, heavily dependent smokers quit successfully every day.
The bottom line
Your FTND score measures how physically addicted to nicotine your body has become. Scores of 0-4 suggest lower dependence where behavioral approaches may work; scores of 5+ indicate significant dependence where medication substantially improves your chances. The score helps you understand what kind of quit attempt to plan. A score of 8-10 isn't a reason for despair. It's information that points you toward the intensive support that actually works for high dependence. Whatever your score, effective treatments exist. The key is matching your approach to your level of dependence.