A history of ADHD has been reported in up to 35 percent of persons seeking treatment for cocaine dependents, but the clinical implications of ADHD in these individuals has not been clearly delineated. The two case examples demonstrate how counseling staff may fail to detect the symptoms of ADHD; the diagnosis of ADHD in the cocaine-addicted individual requires careful assessment and observation over time. An assessment of developmental history, including school performance and the quality of social and family interactions, is necessary. Treatment includes a combination of therapeutic modalities, including relapse prevention and self-help groups, regular urinalysis, and a pharmacotherapy trial. Although the abuse potential of stimulant medications must be taken into consideration, in carefully selected individuals and with careful monitoring, the benefit of treatment may outweigh the risk. The prevalence of cocaine abuse and dependence in ADHD may be partly explained by the self-medication hypothesis of drug abuse. 12 references