Tobacco-Specific Screening and
Assessment Tools
Fagerstrom Test for Nicotine Dependence
(FTND)
The Fagerstrom Test for Nicotine Dependence,
originally developed in 1991, is a six-item
instrument that assesses addiction involving
nicotine (dependence) based on quantity of
cigarette consumption and compulsion to
smoke.^136 It is one of the most commonly used
measures of addiction involving nicotine.^137
Scored from one to 10,^138 the instrument requires
no training to use and can be administered and
scored in less than five minutes.^139
Although the FTND is copyrighted it can be
used and reproduced without the author’s
permission and free of charge.^140
Populations and Settings Served. In addition
to screening for addiction involving nicotine in
cigarette smokers, the FTND has been adapted
for screening for smokeless tobacco use. The
FTND screening tool can be used alone or
incorporated into comprehensive clinical and
non-clinical health screenings.^141 The
instrument also is commonly used in research
settings.^142
Clinical Utility. The FTND is a valid
instrument,^143 with scores reflecting biological
and psychological indicators of addiction
involving nicotine.^144 Among a group of
inpatients with addiction, FTND scores were
significantly correlated with patients’ smoking-
related physical symptoms, frequency and
quantity of cigarette use and with biological
markers such as carbon monoxide and cotinine
levels. FTND scores also are correlated with the
number of puffs per cigarette patients took and
the average amount of time they spent puffing
on cigarettes.^145 The instrument has marginal
internal reliability^146 but high test-retest
reliability.^147 At a score of four or more, the
FTND showed a sensitivity of 94 percent and
specificity of 88 percent among samples from
the U.S. and Spain.^148
Nicotine Dependence Syndrome Scale
(NDSS)
The Nicotine Dependence Syndrome Scale is an
assessment tool that measures five dimensions
of nicotine dependence based on symptoms and
characteristics outlined in the DSM,^149 including
craving and withdrawal (drive), preference for
smoking over other activities (priority),
decreased response to the effects of smoking
(tolerance), patterns of tobacco use (stereotypy)
and smoking at a regular rate (continuity).^150
The NDSS was designed to assess addiction
involving nicotine in a more comprehensive way
than other scales, such as the FTND.^151Population and Settings Served. The NDSS
was designed for adult smokers, but an
adolescent version has been developed.^152Clinical Utility. The NDSS has been found to
be a valid and reliable instrument.^153 Several
studies using samples of smokers of various ages
provide support for the multidimensional nature
of the scale and show that the scale identifies
features of risky tobacco use that are below
clinical thresholds of dependence.^154Alcohol-Specific Screening and
Assessment Tools
The Alcohol Use Disorders Identification
Test (AUDIT)
The Alcohol Use Disorders Identification Test is
a screening tool that was created in 1992 to
identify risky drinking* in adult primary care
settings.^155 The 10-question interview takes
only a few minutes to administer^156 and score^157
and covers consumption levels, drinking* Defined by the developers as “hazardous” and
“harmful” drinking involving an average daily
alcohol intake exceeding 60g per day for men and
40g per day for women; recurrent intoxication;
fulfilling at least one criterion of alcohol dependence
on the drinking behavior scale on a monthly basis;
experiencing at least one alcohol-related problem in
the past year or having an alcohol-related disease or a
perceived drinking problem.