Recent advances in neurobiology, genetics, neuropsychology and brain imaging research have identified various physiopathological mechanisms implicated in cocaine addiction and suggested several promising pharmacological approaches. Clinical targets of the pharmacological treatments are cocaine-induced euphoria and craving. Currently, there is no specific pharmacological therapy with established efficacy for the treatment of cocaine dependence, nor is any medication approved by regulatory authorities for such treatment. However, recent controlled clinical trials have highlighted the promise of several medications, especially N-acetylcysteine, modafinil, topiramate, GABAergic agents, disulfiram, agonist replacement therapy (methylphenidate LP, d-amphetamine). Partial agonists at the dopamine D2 receptor and anticocaine vaccines are other promising treatment approaches. It is important to clearly differentiate the detoxification treatment and the relapse prevention treatment phases.