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

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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