Does the Fagerstrom Nicotine Dependency Test suit every smoker in the waiting room

Fagerstrom Nicotine Dependency Test (FNTD) is a vital test in smoking cessation services. It determines the nicotine addiction level of the patients. The test consists of six items, and a smoker can get a score between 1 to 10. A higher score indicates a higher level of dependency. The result of this test is one of the key components that we use to determine and discuss the best possible individualized cessation strategy (life style modifications, motivation interview, nicotine replacement therapy or other drugs) with patients according to evidence-based medicine principles. It is known that FNTD is a very effective tool for primary care and has several advantages over other self / physician-rated tests. However in several cases we have encountered several flaws and problems in each of the six items with extreme or unusual cases in our experiences. Also such problematic cases are not uncommon in our patient population. To our experience clinicians have to question every item of FNTD with special care in order to prevent and misjudge. This condition may be resulted to under- or over-rate dependency levels of the smokers. In this short report we attempt to share and discuss some of these problematic situations and our own experiences.