Sensitization to cocaine refers to the behavioral model of cocaine addiction where the motor stimulant effect of cocaine is augmented for months after discontinuing a regimen of repeated cocaine injections. There has been speculation that the neuroadaptations mediating this sensitization phenomenon may, in part, underlie the behavioral changes produced by chronic cocaine abuse, including paranoia, craving and relapse. Criteria are proposed that may assist in determining which neuroadaptations are most relevant in this regard. Using these criteria, a model is presented that endeavors to incorporate neuroadaptations issuing directly from the pharmacological effects of cocaine and those arising from learned associations the organism makes with the cocaine injection procedure and pharmacological actions. It is proposed that the pharmacological neuroadaptations predominate in the manifestation of cocaine-induced paranoia, while the changes derived from learning may provide more critical underpinnings for cocaine craving and relapse.