Pharmacotherapies for schizophrenic and cocaine psychoses are complex but similar because of similarities in their brain neurochemistry and behavioral outcomes. Their neurochemical neuronal mechanisms of action, as shown in preclinical and clinical studies, involve primarily dopaminergic dysfunction and, secondarily, neuroadaptive effects that seem to involve central serotonergic function. Behavioral outcomes of both disorders include hyperactivity and antipsychotic medications can ameliorate psychotic symptoms. Patients with both disorders often arrive at emergency departments and present floridly psychotic with a predominance of positive symptoms, often prompting physicians to select a typical antipsychotic medication such as haloperidol. While this has become conventional wisdom, we believe that to use an atypical antipsychotic medication, such as risperidone, in the treatment of both psychoses is quite rational for long-term management of both positive and negative symptoms. Also, controlled clinical studies have shown that risperidone, an atypical antipsychotic medication, is successful in the treatment of cocaine dependence and withdrawal (Smelson et al 1997, 2002; Grabowski et al 2000). Furthermore, the availability and effectiveness of long-acting risperidone in injectable form opens new possibilities for the long-term management of both disorders. In this paper, we present data which show that the use of risperidone is plausible for effective pharmacotherapy of schizophrenic and cocaine psychoses.