Almost 8,000 people died from alcohol-related causes between 2005 and 2014, a third of which were aged under 50
An alcohol treatment assessment was recorded for less than a quarter of those deaths even though most deaths are after years of heavy drinking.
Public Health Wales said this was down to "cultural and service barriers".
The report showed out of 7,901 alcohol-related deaths between 2005 and 2014, 94% of people had previously been admitted to hospital or A&E.
Public Health Wales (PHW) is now leading the call for people to recognise when their drinking may be starting to cause a problem - and act by getting help earlier.
Josie Smith, programme and national lead for substance misuse at PHW, said: "We knew anecdotally, and now from the findings of this report, that not enough people are seeking help for their problems with alcohol.
"People may feel that they do not want to seek support to reduce their drinking due to fear of being labelled an alcoholic, or thinking that they may have to stop drinking altogether.
"We need to break down the stigma and talk more openly and earlier to those that can offer help about any concerns."
Ms Smith added the results of the report are "especially pertinent" as Dry January draws to a close and "some people return to their usual alcohol consumption".
Thousands of high risk drinkers died in Wales without accessing alcohol treatment services despite repeated hospital admission, a report has found.