Despite its high prevalence, pathological gambling often remains untreated. It is estimated that only 10% of the pathological gamblers identified in prevalence studies will enter treatment. Within this small proportion, a high percentage will drop out. Despite the facts that some researchers argue against abstinence as the unique treatment goal and that regaining control appears to be possible for some pathological gamblers, abstinence has been the only treatment goal in most problem gambling interventions thus far. This paper examines the avenue of controlled gambling embedded in a harm reduction context as a viable solution for some pathological gamblers.