Given the important role of the dopamine transporter (DAT) in the addictive properties of cocaine, the development and use of compounds that target the DAT represents a reasonable approach for the pharmacological treatment of cocaine abuse. The present report describes a series of studies conducted in nonhuman primates that evaluated the effectiveness of DAT inhibitors in reducing cocaine self-administration. In addition, drug substitution studies evaluated the abuse liability of the DAT inhibitors. PET neuroimaging studies quantified DAT occupancy at behaviorally relevant doses, characterized the time-course of drug uptake in brain, and documented drug-induced changes in cerebral blood flow as a model of brain activation. Selective DAT inhibitors were effective in reducing cocaine use but high (>70%) levels of DAT occupancy were associated with significant reductions in cocaine self-administration. The selective DAT inhibitors were reliably self-administered but rates of responding were lower than those maintained by cocaine even at higher levels of DAT occupancy. A profile of slow rate of drug uptake in brain accompanied by a gradual increase in extracellular dopamine may account for the more limited reinforcing effectiveness of the DAT inhibitors. Selective serotonin transporter (SERT) inhibitors were also effective in reducing cocaine use and blocked cocaine-induced brain activation and increases in extracellular dopamine. Co-administration of SERT inhibitors with a selective DAT inhibitor was more effective than the DAT inhibitor administered alone, even at comparable levels of DAT occupancy. The results indicate that combined inhibition of DAT and SERT may be a viable approach to treat cocaine addiction. Keywords cocaine; dopamine transporter; serotonin transporter; PET imaging; nonhuman primates Despite extensive efforts directed toward the development of medications to treat cocaine abuse, no effective pharmacotherapy is currently in clinical use. Given the obvious importance of dopaminergic mechanisms in the addictive properties of cocaine, the development and use of compounds that target dopaminergic systems represents a reasonable approach for the pharmacological treatment of cocaine abuse. The therapeutic approach of substitute agonist or replacement medication has been successful in the context of methadone maintenance for heroin dependence and nicotine replacement for tobacco use. These positive outcomes, combined with recent advances in the understanding of the neuropharmacology of cocaine, support efforts to develop a similar type of medication for cocaine abuse. Of the various types of medications being pursued, dopamine transporter (DAT) inhibitors represent a promising approach in drug development (Mello & Negus, 1996;Carroll, Howell, & Kuhar, 1999;Howell & Wilcox, 2001; Corresponding author: Leonard L. Howell, Ph.D., Yerkes National Primate Research Center, Emory University, 954 Gatewood Road NE, Atlanta, GA 30329, lhowell@emory.edu, Phone: 404-727-7786, Fax: 404-727-1266. NIH P...