Cocaine use presents new challenges for Europe’s drug treatment services. Although services can leverage experiences gained in responding to other types of drug problems, the pharmacology of cocaine, the social diversity of users and the concurrent use of other psychoactive substances complicate the development and targeting of responses. And unlike treatment for opioid users, there are no proven effective substitution or pharmacological treatment options currently available for cocaine users. This paper addresses a number of important issues for the delivery of services for cocaine users. How can the different groups of users be reached and helped? What type of treatment should be made available for dependent cocaine users? Are new specialised services needed, or should existing ones be adapted?