Aquatic pharmaceutical pollution poses ecotoxicological risks to the environment and human health. Consumer attitudes and behavior represent a significant source of pharmaceutical compounds found in water. Thus, understanding public perceptions of aquatic pharmaceutical pollution and developing effective risk communication techniques are critical to engaging society in the type of widespread change necessary for addressing the presence of pharmaceuticals in water. This mixed-methods study applies conceptual metaphor theory in conjunction with construal level theory of psychological distance to assess how metaphoric framing affects perceptions of aquatic pharmaceutical contamination across four principal dimensions of psychological distance (geographic, social and temporal distance and uncertainty). Additionally, this study assesses the direct impact of metaphor use on concern and willingness to act, which are positively associated with perceived psychological distance. Data were collected from a convenience sample (n = 20) of university students in Burlington, Vermont using cognitive interviewing. Results indicate that pharmaceutical pollution was initially perceived as geographically distant, socially distant, temporally both proximate and distant and certain (versus uncertain). Our findings suggest people perceive distances in various ways, suggesting a need for validated questions to consistently measure psychological distance. Participants preferred the metaphorically-framed visual intervention to the non-metaphor visual intervention. Further, participants’ perception of pharmaceutical pollution changed to being more geographically and socially close after viewing the metaphoric visual only. Previous research indicates perceived psychological closeness leads to increased motivation and preparedness to act. Theoretical and practical implications of metaphor use in risk communications are discussed.