The main objective of this review was to compare the effectiveness of cognitive-behavioral therapy and contingency management for cocaine dependence. Contingency management alone reliably reduced cocaine use during active treatment in all cited trials, whereas the positive effect of cognitive-behavioral therapy emerged after treatment in 3 of 5 trials. Synergistic effects of the combination of contingency management plus cognitive-behavioral therapy are shown in 2 trials, but another 3 trials found no additive effects. Positive, rapid, and enduring effects on cocaine use are reliably seen with contingency management interventions, whereas measurable effects of cognitive-behavioral therapy emerge after treatment and are not as reliable as effects with contingency management.