Cocaine abuse treatment has begun to use a variety of adjunctive pharmacotherapies. These medications have been used for both acute crash symptoms and long-term prevention of relapse. A phasic model of recovery was integrated with a patient typology to formulate guidelines for using these rapidly evolving pharmacotherapies. The phases are crash, with-drawal, and extinction, and the patient typology includes psychiatric vulnerability and severity of cocaine abuse as contributors to the neuroadaptation that requires pharmacological amelioration. These guidelines address five issues: whom to treat, when to treat, what treatments are available, where to initiate and maintain treatment, and how to match patients to treatment options.