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Gambling disorder affects up to 1.3% of adults worldwide and is associated with elevated rates of suicide, substantial financial harm, and family disruption. Despite this burden, outcome data for residential treatment programs are sparse, and follow-up of high-intensity inpatient interventions rarely extends beyond one year in the gambling literature. This mixed methods study examined outcomes among 36 individuals six months to eight years following residential treatment for co-occurring gambling and substance use disorders using quantitative measures of gambling behavior, substance use, psychiatric symptoms, and functional outcomes alongside qualitative interviews of recovery experiences. Although 61% reported post discharge gambling, participants demonstrated significant improvements in craving strength (-24.4, p=0.001), life satisfaction (+21.3, p=0.005), functional interference (-58.6, p<0.001), and alcohol use (p=0.008), with employment increasing from 25% to 66.7%. Recovery trajectories were heterogeneous, with 5.6% of participants individuals experiencing brief lapses, 27.8% of participants returning to use and later achieving sustained abstinence, and another 27.8% of participants continuing active use. Leaving treatment prior to staff initiated discharge was associated with earlier return to gambling (HR=3.26, p=0.02) and higher odds of post discharge gambling (OR=7.08, p=0.062). Qualitative findings highlighted mechanisms including environmental restructuring, development of coping skills, structured routines, and maintenance of post discharge support. Residential treatment was associated with durable improvements in functioning and gambling related distress, even in the absence of complete abstinence, supporting its role in the management of severe gambling disorder.