Smoking Cessation Community

One of the most widely used questionnaires designed to measure the strength of addiction to cigarettes is called the "Fagerstrom Test for Nicotine Dependence" or FTND . It is a 6-item questionnaire, yielding a score from 0-10, with a higher score implying stronger addiction. Dr Karl Fagerstrom, the Swedish researcher who originally developed the FTND recently published a study that examined the relationship between baseline (pre quit attempt) FTND score and success in quitting smoking among almost 5000 smokers who participated in placebo-controlled trials of varenicline (marketed as Chantix in the USA). The study confirmed that smokers with lower pre-quit FTND scores had a much better chance of successfully quitting 6 months later. For example, smokers with the lowest scores (0-1) were twice as likely to successfully quit smoking as those with the highest scores (9-10). The study also found that a shorter, two-question version was just about as predictive of success in quitting smoking. The two key questions were:
1. How many cigarettes per day do you smoke?
2. How soon after you wake do you smoke your first cigarette of the day?
Those who smoke more than 30 cigarettes per day or smoke within 5 minutes of waking in the morning have a lower quit rate than those who smoke less than 11 cigarettes per day and typically don't smoke their first of the day until over an hour after waking in the morning. It appears that these two questions on their own can give a reasonable but fairly rough guide to how addicted a smoker is. I say "fairly rough" because even among those scoring a zero on these addiction assessments (i.e. the least addicted), the six month quit rate among those receiving placebo in the clinical trials was only twenty percent. This suggests to me that significant addiction is present among people who smoke less than 11 cigarettes per day. It also suggests that we need some additional questions that can help measure level of addiction at the low levels of daily cigarette consumption (i.e. <11 per day). It is unclear whether an individual actively delaying the first smoke of the day and reducing their daily cigarette consumption over time can make themselves "less addicted". It is possible, if sustained over a reasonably long period (i.e. greater than a month). However, perhaps a more practical use of these types of quick addiction assessments is to guide the smoker about whether they would likely benefit from assistance in quitting (e.g. counseling and/or medication). It seems that people who smoke just a few cigarettes per day and don't smoke within an hour of waking in the morning may have a good chance of success by picking a day and making a serious quit attempt on their own. Heavier smokers may be more likely to benefit from additional assistance. However, in this recent study, even those who had a zero score on the addiction questionnaires were more than twice as likely to successfully quit smoking for 6 months if they received varenicline as compared to those receiving placebo (47% v 20%).