The natural course of gambling disorders was examined in 40 active pathological gamblers following a three-and-a-half-year period. The majority who reported intentions to quit or reduce gambling made a serious change attempt; however, at follow-up most were gambling problematically. Emotional and financial factors were important precipitants of attempts to quit as well as reasons for relapse. A substantial number experienced a depressive episode or substance use disorder during the follow-up period. A number reported quitting drinking and smoking concurrent with quitting gambling. Less than half had treatment for their gambling problem during the follow-up interval. The few participants who were currently gambling but no longer experiencing gambling problems reported less serious gambling problems initially. In contrast, the successfully abstinent group reported more gambling problems initially. This study provides important directions for future research. Abstinence may be more feasible for individuals experiencing more serious problems, whereas non-abstinent goals may be realistic for individuals with fewer negative consequences.