Thirty‐five chronic cocaine users were offered carbamazepine in an open clinical trial as an adjunct to outpatient treatment for cocaine dependence. Nine patients refused ongoing carbamazepine treatment, 13 decreased their cocaine use from 65/100 days pretreatment to 2.8/100 days with treatment (2,562 days at risk), and 13 had a reduction from 78.1/100 days pretreatment to 35.1/100 days with treatment (2,790 total days at risk). The 9 carbamazepine refusers had virtually no change in their cocaine use. The degree of patient compliance with carbamazepine intake correlated directly with decreased cocaine use and with lowered craving intensity, frequency, and duratio