Background <p>Excessive drinking is a known risk factor for psychological distress; however, the role of alcohol tolerance in this relationship remains unclear. This study examined the association between excessive drinking and psychological distress among agricultural workers in Japan by focusing on the potential moderating effect of alcohol tolerance.</p> Methods <p>A cross-sectional questionnaire survey was conducted among agricultural workers in City A, Akita Prefecture, Japan, between November 2024 and January 2025. Excessive drinking was defined as an alcohol use disorders identification test score ≥ 15, and psychological distress was assessed using the Kessler 6 scale (cut-off ≥ 13). Alcohol tolerance was determined based on self-reported facial flushing. Multivariate logistic regression analysis was performed to examine associations after adjusting for confounders. Stratified analyses were conducted to assess differences based on alcohol tolerance.</p> Results <p>Among the 169 participants, 15 (8.8%) reported psychological distress. Excessive drinking was significantly associated with psychological distress (odds ratio [OR] 6.41, 95% confidence interval [CI] 1.62–25.28, <i>p</i> &lt; 0.001). Stratified analysis showed a significant association only among individuals with alcohol tolerance (OR 28.66, 95% CI 3.26–251.89, <i>p</i> &lt; 0.001), whereas no significant association was observed among those without alcohol tolerance (OR 0.88, 95% CI 0.09–8.54, <i>p</i> = 0.91).</p> Conclusions <p>Alcohol tolerance moderated the relationship between excessive drinking and psychological distress. These findings suggest that alcohol tolerance may be an important factor to consider when examining this association.</p>