Thirty-four male alcoholics underwent sequential liver biopsies as part of their evaluation. Of 19 subjects with simple fatty livers, only three showed progression of liver disease: one developed perivenular fibrosis after two years; a second showed no progression after three years, but developed perivenular fibrosis after four years; the third subject likewise showed no progression after one year, but developed incomplete cirrhosis after six years. In contrast, of 15 subjects with perivenular fibrosis at the time of the initial biopsy, 13 progressed to more severe stages of liver disease during a one- to four-year follow-up interval. Nine developed fibrosis, one developed incomplete cirrhosis and three developed cirrhosis. Thus, patients with perivenular fibrosis at the fatty liver stage are likely to progress to more severe stages of alcoholic liver disease if they continue to consume alcohol.