Poor relationship quality can increase an individual’s psychological distress. There is substantial debate regarding the influence of relationship quality for men and women. Some have found that women’s psychological distress is affected more by poor relationship quality compared to men. Others have found that psychological distress is equally affected for men and women, but it may look different—depressive symptoms for women and total alcohol consumption for men. In this study we examined how men and women differed in changes in relationship quality and changes in psychological distress. Then, we examined how changes in one manifestation of psychological distress and changes in relationship quality were related and how this association differed for men and women. Women reported lower initial relationship quality and total alcohol consumption but higher initial depressive symptoms. Men and women only differed on changes in total alcohol consumption, with women decreasing less than men over 25 years. Finally, both changes in total alcohol consumption and changes in depressive symptoms were related to changes in relationship quality for women, but not men. The reverse direction did not differ by gender, although change in depressive symptoms was related to change in relationship quality. Implications for future research are discussed