This study tested the relationship of intrusive and avoidant thoughts about cocaine to early treatment outcome in crack users entering inpatient treatment. As part of a study comparing the effects of desipramine versus placebo, 57 Ss completed a modified version of the Impact of Event Scale, the Profile of Mood States, and a craving scale. For the placebo group only, significant correlations were found between baseline intrusion scores and the 3 outcome measures at 1 week postdischarge, including self-reported cocaine use confirmed by urinalysis. The addition of intrusion scores to craving and mood significantly improved the ability to predict whether the patient was in treatment at the 1-week follow-up assessment. For the desipramine group, intrusions were not related to outcomes. Thus, desipramine may interrupt the neurochemical and psychological reactivity from intrusive thoughts about cocaine.Relatively little is known about the most effective treatment combinations for cocaine abuse (cf.