The dopamine system is a primary treatment target for cocaine dependence (CD), but research on dopaminergic abnormalities (eg, D 2 receptor system deficiencies) has so far failed to translate into effective treatment strategies. The D 3 receptor system has recently attracted considerable clinical interest, and D 3 antagonism is now under investigation as a novel avenue for addiction treatment. The objective here was to evaluate the status and behavioral relevance of the D 3 receptor system in CD, using the positron emission tomography (PET) radiotracer [11 C]-(+)-PHNO. Fifteen CD subjects (many actively using, but all abstinent 7–240 days on scan day) and fifteen matched healthy control (HC) subjects completed two PET scans: one with [11 C]-(+)-PHNO to assess D 3 receptor binding (BP ND; calculated regionally using the simplified reference tissue model), and for comparison, a second scan with [11 C] raclopride to assess D 2/3 binding. CD subjects also completed a behavioral battery to characterize the addiction behavioral phenotype. CD subjects showed higher [11 C]-(+)-PHNO BP ND than HC in the substantia nigra, which correlated with behavioral impulsiveness and risky decision making. In contrast,[11 C] raclopride BP ND was lower across the striatum in CD, consistent with previous literature in⩾ 2 week abstinence. The data suggest that in contrast to a D 2 deficiency, CD individuals may have heightened D 3 receptor levels, which could contribute to addiction-relevant traits. D 3 upregulation is emerging as a biomarker in preclinical models of addiction, and human PET studies of this receptor system can help guide novel pharmacological strategies for treatment.