This brief review of pharmacological approaches suggests that, with the exception of pharmacotherapies targeted towards accurately and appropriately diagnosed comorbid conditions such as affective disorders, psychotic disorders, attention deficit disorders and opioid dependence, the use of pharmacotherapies for the promotion or maintenance of psychostimulant abstinence or the management of psychostimulant withdrawal continues to be experimental. The inherent risks of pharmacotherapy may suggest that the use of pharmacotherapeutic agents should be limited to users diagnosed with more severe dependence who experience the greatest burden of psychostimulant-related harms. Indeed recent re-analysis of trials of the dopamine agonist amantadine (Kampman, Volpicelli, Alterman, Cornish & O'Brien, 2000) and the beta blocker propranolol (Kampman, Volpicelli, Mulvaney, Alterman et al., 2001) found that subjects displaying significant cocaine withdrawal (suggestive of neuroadaption) responded selectively to treatment (see also Dackis & O'Brien, 2002).The absence of good data on the natural history of psychostimulant use and psychostimulant induced neuroadaption has, in the past, contributed to a 'scatter gun' approach to investigating potential pharmacotherapies, especially for cocaine. Research on treatment for amphetamine dependence is at a much earlier stage and may benefit by lessons already learned from the cocaine experience. This experience particularly points to the need for rigorous, controlled studies with adequate follow-up, sample sizes, selection of appropriate subjects and the integration of psychosocial interventions.