Determinants of Tobacco Use and Renaming the FTND to the Fagerstrom Test for Cigarette Dependence

When the first version (the Tolerance Questionnaire, Fagerström, 1978) of the Fagerström Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker, & Fagerström, 1991) was developed, tobacco smoking was not regarded as an addiction. Nevertheless, evidence that this might be the case was beginning to appear, and some researchers became increasingly interested in investigating the importance of nicotine in the smoking habit and educating the public about it. The research led to a profound change in the understanding of cigarette smoking, and in 1988, the U.S. Surgeon General, in the remarkable book Nicotine Addiction, established once and “forever” the importance of nicotine in tobacco smoking (U.S. Department of Health and Human Services U.S. DHHS, 1988). However, as the role of nicotine was established, researchers lost sight of the possibility that other determinants might also be important. More recently, it has been found that, although nicotine is the most important addictive component of tobacco smoke, it is probably not the only substance involved in the development of tobacco dependence. In light of what is now known about what determines cigarette smoking, it seems timely to propose a renaming of the FTND to the Fagerström Test for Cigarette Dependence (FTCD). The background for this is discussed in this commentary.