In this long-term follow-up evaluation of chronic alcoholics without established cirrhosis we investigated the influence of alcohol on the progression of fibrosis and the prognostic significance of histological features. We were unable to confirm results of retrospective cross-sectional analysis suggesting a linear relationship between alcohol intake and the development of cirrhosis. Alcoholic hepatitis, advanced fibrosis, central hyaline necrosis and central vein sclerosis were unfavorable signs for the further course of the disease. All but one of the patients with central vein sclerosis who progressed to advanced fibrosis also had an alcoholic hepatitis in one of their biopsies. Two patients had an acute alcoholic hepatitis initially, and later showed the mixed histological pattern of an alcohol-induced chronic active hepatitis, a pattern which was also seen in four other patients, all progressing to cirrhosis. This may be taken as evidence that immunological factors contribute in some patients to progression of fibrosis.