Fagerstrom Test For Nicotine Addiction

How does this Fagerstrom test for nicotine addiction work?

This health tool aims to screen for the degree of nicotine dependence by quantifying smoking habits and symptoms. Each of the results is then correlated with a recommendation of either further screening and referring for NRT (nicotine replacement therapy) or of simple withdrawal symptoms monitoring.

The Fagerstrom test for nicotine addiction refers to the following situations:

■ Time in minutes before first cigarette of the day;

■ Difficulty in refraining from smoking in places where it is forbidden;

■ Particular cigarette of the day that is considered most important;

■ Number of cigarettes smoked per day;

■ The time period of the day with the most smoked cigarettes;

■ Smoking during periods of illness.

Nicotine addiction is the most commonly met type of physical dependence, also with a higher frequency of relapse. Some guidelines allocate the number of 10 – 15 cigarettes per day as cut off for observed nicotine dependence.

Most of the criticism received by this assessment method regards lack of sensitivity for lower scores and the failure of recognizing dependency in the cases of light smokers.

Fagerstrom score interpretation

The test comprises of 6 items with different numbers of points awarded, depending on the gravity of the dependence symptoms.

There are three multiple choice items scored from 0 to 3 and three yes/ no items scored 0 for no and 1 for yes.

The minimum score available in the Fagerstrom test is 0, indicating no dependence and the maximum score is 10, indicating very high nicotine dependence.

The recommendation is that, as the level of dependence increases, the patient’s need to be referred for nicotine replacement therapy increases. For higher demonstrated levels of dependence, combined therapy might also be required.

Another recommendation is that in the case of scores of 3 and above, the subject should be referred for further screening.

The following table presents the Fagerstrom score ranges and their correlation with levels of smoking addiction:

Nicotine Replacement Therapy (NRT)

This is the term used to describe the medically approved methods of using nicotine to ease smoking cessation and to relive withdrawal symptoms. By several means, nicotine is brought to the blood stream without smoking or in parallel with gradually cutting down on smoked cigarettes.

This type of therapy requires accurate establishing of the beginning dose and constant monitoring for reductions in the long term. The minimum length of treatment is usually 8 – 12 weeks for ensuring positive results. While success rates are of 50 - 70%, the overall results are highly dependant on the ability of the patient to follow the treatment. Adverse reactions include risk of nicotine poisoning and continued addiction.

Forms of NRTs include patches, lozenges, chewing gum or nose sprays. There are also other medicines available to stop smoking such as varenicline or bupropion but these are different from NRTs.

References

1) Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom K. (1991) The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction; 86:1119-1127.

2) Fagerstrom K, Furberg H. (2008) A comparison of the Fagerstrom Test for Nicotine Dependence and smoking prevalence across countries. Addiction; 103(5): 841–845.

3) Meneses-Gaya IC, Zuardi AW, Loureiro SR, Souza Crippa JA. Psychometric properties of the Fagerstrom Test for Nicotine Dependence. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

4) Storr CL, Reboussin BA, Anthony JC. (2005) The Fagerstrom test for nicotine dependence: a comparison of standard scoring and latent class analysis approaches. Drug Alcohol Depend; 80(2):241-50.