The below test is for physical dependence.  In fact, psychological dependence is present in almost all smokers.  Contrary to what is popularly believed, psychological dependence is not something that can be wished away.  It consists of actual nervous system connections that become programmed into the nervous system with the very first cigarette that one smokes.  This conditioning makes smoking very difficult to quit and is actually the powerful driving force behind nicotine addiction.  These connections do fade with time when a patient gives up smoking.  Counter-conditioning appears to be able to cause these connections to fade more quickly.

Still, physical dependence is an important factor.  It determines how much drug withdrawal the patient will probably have to deal with on stopping smoking.  It provides guidance for whether higher dose rather than lower dose nicotine products might help wean the patient off of cigarettes in addition to a counseling or mild aversion treatment program.  Of course, the stronger the dependence, the more the patient will have to work to become tobacco free.  Actually, many of the people in my groups are highly dependent.  Dependent or not, tobacco kills.  Dependent or not, getting off tobacco is extremely important.

Fagerström Test for Nicotine Dependence

The Fagerström Test assesses the extent to which nicotine controls the patient's behavior. Health care professionals may have their patients complete the form to determine their scores prior to counseling.

1. How soon after you wake up do you have your first cigarette?

A. Within 5 minutes (3)
B. 6-30 minutes (2)
C. 31-60 minutes (1)
D. After 60 minutes (0)

2. Do you find it difficult to refrain from smoking in places where it is forbidden, e.g., in church, the library, and cinema, etc?

A. Yes (1)
B. No (0)

3. Which cigarette would you hate most to give up?

A. The first one in the morning (1)
B. All others (0)

4. How many cigarettes/day do you smoke?

A. 10 or fewer (0)
B. 11-20 (1)
C. 21-30 (2)
D. 31 or more (3)

5. Do you smoke more frequently during the first hours after waking than during the rest of the day?

A. Yes (1)
B. No (0)

6. Do you smoke even if you are so ill that you are in bed most of the day?

A. Yes (1)
B. No (0)

Scoring:
7 to 10 points = highly dependent; 4 to 6 points = moderately dependent; less than 4 points = minimally dependent.

The higher the score, the more likely the patient is to experience withdrawal symptoms and the symptoms are likely to be stronger.

Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström test for nicotine dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991;86:1119-27.