Instructions: Answer the following questions. Based on your score, you will be able to see what your level of nicotine dependence is.

1. How soon after you wake up do you smoke your first cigarette?
     After 60 minutes
     31 to 60 minutes
     6 to 30 minutes
     Within 5 minutes
   
2. Do you find it difficult to refrain from smoking in places where it is forbidden?
     No
     Yes
   
3. Which cigarette would you hate most to give up?
     The first in the morning
     Any other
   
4. How many cigarettes per day do you smoke?
     10 or less
     11 to 20
     21 to 30
     31 or more
   
5. Do you smoke more frequently during the first hours after awakening than during the rest of the day?
     No
     Yes
   
6. Do you smoke if you are so ill that you are in bed most of the day?
     No
     Yes
   

Total Score =

If you score 5 points, your level of nicotine dependence is moderate; if you score 6 to 7 points, your level of nicotine dependence is high; and if you score 8 to 10 points, your level of nicotine dependence is very high. If your level of nicotine dependence is moderate, high, or very high, you and your doctor should consider various medications to help you stop smoking.

If you score 4 points or lower, your level of nicotine dependence is low. You probably will be able to succeed in stopping smoking without medication.

*Adapted from: Heatherton, TF, Kozlowski LT, Frecker RC,Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction 1991;86:1119-27.