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What Is The Fagerstrom Test For Nicotine Dependence?

Nicotine is a central nervous system stimulant and is produced by a natural process in various families of plants. It is a highly addictive substance commonly taken in the form of smoke via cigarettes, chewed like tobacco, etc. It is started as an occasional substance to be used and later converts into an addiction. To diagnose the addiction and dependence a test was developed in the form of a questionnaire known as Fagerstrom test.

What Is The Fagerstrom Test For Nicotine Dependence?

Fagerstrom test is a questionnaire originally prepared by Karl-Olov Fagerström in late 20th century and was modified by Todd Heatherton, et al. in 1991.[1] It is used to detect and diagnose the nicotine addiction and dependence. It can also predict the severity and the likely outcome of the current situation if no intervention is done. It consists of 6 questions related to the consumption of nicotine in the form of cigarettes. Marks are scored for each question between 0 to 3 for some questions and 0 to 1 for a few other questions. The total marks are calculated at the end and classified in various categories.

The first question asked in it is – What is the time period between the first time you wake in the morning and lighting the first cigarette. The options given for this question are 0 to 5 minutes, 6 to 30 minutes, 31 to 60 minutes, 61 minutes or above and the marks are given as 3, 2, 1, and 0 respectively.

The second question is – Is it difficult for you to prevent yourself from smoking or do you feel tempted to smoke at socially forbidden places like temple, etc? If the answer is yes the person is awarded 1 mark and if the answer is no then 0 marks are awarded.

The third question asked in it is- Which cigarette is most difficult or you hate the most to give up? The options provided are the first cigarette in the morning and any other cigarette in the day. One mark is awarded for the first option and no mark is awarded for the second option.

The fourth question in the questionnaire is- How many cigarettes you smoke per day? Four options are provided for this question which is as follows:- 0 to 10 cigarettes, 11 to 20 cigarettes, 21 to 30 cigarettes, and 31 or more cigarettes. The marks awarded for each option are 0, 1, 2 and 3 respectively.

The fifth question is- Is the frequency of smoking more during the initial hours after awakening in the morning or are they more during the whole day? The options are either yes or no. 1 mark is awarded for yes and 0 marks are awarded for no.

The sixth question asked in it is- Do you even smoke cigarettes when you are so ill that you are lying on your bed for the most part of the day? The options are either yes or no. 1 mark is awarded for yes and 0 marks are awarded for no.[2]

The maximum score in this questionnaire is 10 and the minimum score is 0. It is classified in three categories, category I include scores between 0 to 3 which corresponds to mild dependence, category II includes scores between 4 to 6 which corresponds to moderate dependence and category III includes scores between 7 to 10 which corresponds to severe dependence.[3]


It is a test developed for the medical personnel to help with the diagnosis of nicotine addiction. It classifies the patients into three categories based upon their degree of dependence on nicotine. Mild to moderate dependence is observed below the scores of 7 wheres the patient is labeled as a severe dependent if the score is 7 or above. It is a very good diagnostic test but a few drawbacks are there because it is a subjective score depending upon the patient’s response and its credibility is questionable.


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Sheetal DeCaria, M.D.
Sheetal DeCaria, M.D.
Written, Edited or Reviewed By: Sheetal DeCaria, M.D. This article does not provide medical advice. See disclaimer
Last Modified On:August 26, 2019

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