Brief Description
The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used assessment designed to evaluate the intensity of physical addiction to nicotine. It consists of seven total questions, with six questions assessing various aspects of smoking behavior, such as the time to the first cigarette after waking, the number of cigarettes smoked daily, and the difficulty of refraining from smoking in certain situations. Each response is scored, and the total score classifies the individual's level of nicotine dependence, ranging from very low to very high. The FTND helps providers tailor treatment and cessation strategies based on the individual's dependence level.
Assessment Administration Type
Self-report
Number of questions
7
Age Range for Administration
18+
Recommended Frequency of Administration
No recommended standard frequency. Blueprint recommends using this as a screening tool to assess level of nicotine dependence.
Summary of Scoring and Interpretations
The first item of the FTND asks whether the respondent uses nicotine. In the instructions, it is noted that only those who respond “yes” on question should proceed. Item one is not included in the FTND total score. The total score is a sum of the responses to items two through six, with higher scores indicating more dependence on nicotine. See the table below for descriptions associated with each total score.
Total Score (Sum of Items 2-6) | Description |
0-2 | Very low dependence on nicotine |
2-4 | Low level of dependence on nicotine |
5 | Medium level of dependence on nicotine |
6-7 | High level of dependence on nicotine |
8-10 | Very high level of dependence on nicotine |
Blueprint Adjustments
Blueprint utilizes the clinical cut-off scores described above, although there is some variability in cut-off scores cited in the literature.
Clinical Considerations
Estimated completion time: 2-3 minutes
The FTND should only be interpreted if the respondent selects “Yes” for item one.
The FTND specifically measures physical dependence on nicotine, focusing on factors like withdrawal symptoms and the need for nicotine to function normally. The FTND does not assess psychological or behavioral components of nicotine dependence (e.g., habit or emotional triggers), which can also play a significant role in tobacco use.
The FTND was originally designed for cigarette smokers and may not fully capture nicotine dependence in those using alternative forms of nicotine, such as e-cigarettes, smokeless tobacco, or nicotine patches.
There is no research evidence providing clear recommendations for frequency of administration. However, based on monitoring of smoking cessation progress, it could be helpful to administer the FTND at regular intervals (e.g., every 1-2 months) to reassess dependence, track behavioral changes, and adjust treatment plans.
Blueprint also has the Hooked on Nicotine Checklist (HONC) available, which can be used with adolescents and adults and is particularly useful for those new to nicotine use and/or intermittent users.
Citation
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