Background: Reducing the use of tobacco is currently the most important public health measure that developed countries can implement. Adherence to treatment is an important determinant of the success of smoking cessation programs. Therapeutic patient education (TPE) might play a key role to improve treatment adherence and smoking cessation rates. Our study aimed to compare the effect of intensive and minimal TPE sessions on Nicotine Replacement Therapy (NRT) adherence and smoking cessation rates. Methods: A prospective cohort study was conducted at the smoking cessation center of the University hospital of Monastir. The population study involved the attendees of the center who consulted during the period from 2009 to 2013. Two groups were defined: A group received only two TPE sessions: “Minimal intervention”; and the other benefited of 3 and more: “Intensive intervention”. Results: In total, 48.7% of included patients were adherent to NRT. The level of adherence was significantly associated with the number of TPE sessions (p-value<10-4). Patients with intensive intervention documented higher rates of treatment adherence (Adjusted Relative Risk RRa: 10.98; 95% CI: 4.42-27.02). The smoking cessation rates at one year and five years of follow-up were also associated with the number of TPE sessions with a higher probability of smoking cessation among those who received intensive intervention. Crude Relative Risks were (RRc=2.6; 95% CI :1.3 - 5.4) and (RRc = 2.8; 95% CI:1.3–6.4) at one year and five-years of follow-up, respectively. Conclusions: Intensive TPE sessions are more effective on NRT adherence and on continuous smoking cessation. TPE improves smoking cessation clinics outcomes. A continuous attendance of the counseling sessions with intensive TPE sessions should be recommended as a best practice in smoking cessation programs.