Jusqu’à la fin des années 1970, la consommation de cocaïne n’est pas considérée comme un problème de santé publique. Avec l’arrivée de la cocaïne fumée (free-base) au milieu des années 1970, puis du crack au début des années 1980, le nombre de consommateurs de cocaïne s’accroît régulièrement en Amérique et en Europe, entraînant une augmentation importante des demandes de soins mais aussi une augmentation préoccupante du nombre et de la sévérité des cas d’intoxications liées à sa consommation. Cependant, il n’existe toujours pas de traitement pharmacologique ayant fait la preuve de son efficacité. La prise en charge psychothérapeutique reste le socle principal de la prise en charge, qui doit être pluridisciplinaire et multimodale.

Until the late 1970s, cocaine use was not considered a public health problem. With the arrival of free-base cocaine in the mid-1970s and crack cocaine in the early 1980s, the number of cocaine users has been steadily increasing in America and Europe, resulting in a significant increase in the number of cocaine users, but also a worrying increase in the number and severity of cocaine-related intoxications. However, there is still no pharmacological treatment that has proved its effectiveness. Psychotherapeutic approach remains the mainstay of care, which must be multidisciplinary and multimodal. Our purpose is to present a focus on state-of-the-art learning from literature review on psychotherapy and pharmacotherapy of cocaine addiction. We first describe a short history of cocaine and crack use and describe epidemiological and clinical issues relative to cocaine addiction. We then discuss current pharmacological treatments (agonist and antagonist therapies; anti-craving agents; clinical trials in humans and animal models), including strategies for cocaine use during maintenance therapy for opiate use disorders. Finally, we present neurostimulation techniques as a novel therapeutic tool to inhibit drug cue-associated behaviors and reduce cocaine craving.