This research evaluated the prevalence of general symptoms of psychological distress, the degree to which these symptoms related to alcohol use and alcohol-related negative consequences, and gender-specific relationships among alcohol use, alcohol consequences, and symptoms of psychological distress. The sample included 1705 students drawn from a random sample of three West Coast universities who completed the survey. Results revealed higher levels of consumption and more negative drinking consequences for men, more psychological distress symptoms reported by women, and stronger relationships between psychological symptoms and drinking consequences than use per se. The association between psychological distress and negative drinking consequences was stronger among men than women. The present findings suggest that a focus on negative consequences of alcohol use in addition to the use itself may have greater utility in identifying students at risk for comorbid psychological distress to provide intervention.