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Addiction questionnaire
Addiction questionnaire
How addicted to nicotine are you?
(Fagerstrom test for nicotine dependance)
1. How soon after waking up do you smoke your first cigarette?
---------------- Select ----------------
Within 5 minutes
6-30 minutes
31-60 minutes
2. Do you find it difficult to not smoke when not able to get a break ie: work, movies, travel?
---------------- Select ----------------
Yes
No
3. Which cigarette would you find hardest to give up?
---------------- Select ----------------
The first one in the morning
Any other
4. How many cigarettes a day do you smoke?
---------------- Select ----------------
10 or less
11-20
21-30
31 or more
5. Do you smoke more frequently in the morning than the rest of the day?
---------------- Select ----------------
Yes
No
6. Do you smoke even though you are sick in bed for most of the day?
---------------- Select ----------------
Yes
No
The Fagerstrom test gives you a score between 1 and 10. The higher the score, the more likely you are to benefit from using NRT to assist with withdrawal symptoms and to quit. Those with a score over 5 should consider using an NRT product. Those with a score of 3-4 may still benefit from discussing treatment options with their health professional.
NRT is usually not recommended for those smoking less than 10 cigarettes a day and not smoking within the first hour of waking. Use of NRT is not recommended for those with heart and vascular disease or during pregnancy.
Reference: Frecher RC & Fagerstrom KO (1991) The Fagerstrom Test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire, British Journal of Addiction, 86 pp 1119-1127