This study investigated the association between perfectionism (categorized by adaptive perfectionistic, maladaptive perfectionistic, or nonperfectionistic groups), perceived stress, drinking alcohol to cope, and alcohol-related problems in a large sample of college students (N = 354). Maladaptive perfectionists reported significantly higher levels of stress and drinking to cope than adaptive perfectionists and nonperfectionists. Adaptive perfectionists reported the fewest alcohol-related problems, suggesting that healthy levels of high standards may protect against drinking to cope with stress. Across all participants, a significant indirect effect for drinking to cope supported its role as a mediator between stress and alcohol-related problems. Structural equation modeling analyses supported the moderating role of perfectionism in this mediation model, such that maladaptive perfectionists were more likely to drink to cope under stress and report alcohol-related problems, whereas higher stress was associated with fewer alcohol-related problems among nonperfectionists. Additional analyses revealed higher stress levels for women and a stronger link between stress and drinking to cope for women compared to men. Future research directions as well as clinical implications regarding perfectionism, stress, drinking to cope, and alcohol-related problems are discussed. (Contains 2 tables, 2 figures, and 1 footnote.)