© NSW Ministry of Health 2016SHPN
(
CPH
)
160011
TOOL
• All clients who smoke should be assessed for nicotine dependence.
• There is no need to do the full Fagerstrom test for nicotine dependence – asking three simple questions will
su ce to determine if the client is nicotine dependent (see box below).
• The time to fi rst cigarette is a stronger indicator of nicotine dependence than the number of cigarettes
smoked. A previous experience of withdrawal symptoms during a quit attempt is also a sign of nicotine
dependence.
• A client who is nicotine dependent is likely to need NRT while they are in hospital and are unable to smoke.
This will help to manage cravings and nicotine withdrawal symptoms.
Question to ask Response indicating nicotine dependence
“How soon after waking do you smoke your fi rst cigarette?” Within 30 minutes of waking
“How many cigarettes do you smoke on a typical day?” More than 10 cigarettes per day
“If you have previously attempted to quit, did you
experience withdrawals or cravings?”
A history of withdrawal symptoms in
previous quit attempts
Client is considered to be nicotine dependent if a positive response is given to one or more of the
above questions.
Identifying cravings and withdrawal symptoms
What is a craving?
A craving is when the smoker continuously ‘thinks about’ or ‘longs for’ a cigarette and cannot suppress the
‘urge to use’ tobacco.
What are nicotine withdrawal symptoms?
Smokers may not be aware of all the withdrawal symptoms that are linked to smoking cessation.
The following list includes the most common (but not all) nicotine withdrawal symptoms:
• Cravings • Insomnia / trouble getting to sleep or staying asleep
• Anxiety • Irritability, frustration, anger
• Restlessness • Di culty concentrating
• Depressed mood • Nausea
• Decreased heart rate • Feeling hungry/increased appetite
Notes:
• Other symptoms may include coughing/sore throat, feeling light-headed/dizzy, headache, mouth ulcers,
constipation, dreaming/nightmares. These symptoms can occur for other reasons so caution should be exercised
in attributing them to nicotine withdrawal.
• Ensure clients are provided with enough NRT to control withdrawal symptoms.
(See Tool 4 ‘Flowchart for NRT use in hospital’.)
• Record data related to cravings and withdrawal symptoms in the client’s medical notes.
(Use NSW Health ‘Monitoring chart for symptoms of nicotine withdrawal’.)
• Consumer fact sheet on nicotine dependence and withdrawal available to download and order from the NSW
Health website:
www.health.nsw.gov.au/tobacco/Pages/benefi ts-of-quitting.aspx
Assessing nicotine
dependence
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