Cocaine has been proclaimed the "drug of greatest national public health concern." Recent clinical investigations demonstrate that cocaine causes abuse and withdrawal patterns differing from those of other major abused drugs. These observations converge with preclinical data to suggest that cocaine dependence, rather than being a purely "psychological" addiction, is based in neurophysiological down-regulation in specific central nervous system processes that regulate hedonic (pleasure) responses. Promising new experimental pharmacological treatments have consequently appeared, as have specialized psychotherapeutic approaches to cocaine abuse.