Take the Tobacco Dependency quiz below to determine your level of addiction to nicotine. You may want to print out the quiz and bring it with you to your first Tobacco Cessation counseling session.
How many cigarettes per day do you smoke? | Points |
|---|---|
10 or less | 0 |
11 - 20 | 1 |
21 - 30 | 2 |
31 or more | 3 |
Smokeless: How many tins or pouches per week? | Points |
|---|---|
Low: less than one per week | 1 |
Moderate: 2-3 per week | 1 |
Severe: More than 3 per week | 2 |
31 or more | 3 |
How soon after you wake up do you smoke your | Points |
|---|---|
Within 5 minutes | 3 |
6 - 30 minutes | 2 |
31 - 60 minutes | 1 |
After 60 minutes | 0 |
Do you smoke/chew more frequently during the first hours after awakening than during the rest of the day? | Points |
|---|---|
Yes | 1 |
No | 0 |
Which cigarette/chew would you hate most to give up? | Points |
|---|---|
The first one in the morning. | 1 |
Any other | 0 |
Do you find it difficult to refrain from tobacco in places where it is forbidden, e.g., in church, at the library, in a movie theater? | Points |
|---|---|
Yes | 1 |
No | 0 |
Do you use tobacco if you are so ill that you are in bed most of the day? | Points |
|---|---|
Yes | 1 |
No | 0 |
SCORE | Level of Dependence |
|---|---|
6 - 10 | Severe |
4 - 5 | Moderate |
3 or less | Mild |
