The 40-year period of Hoxha's rule was politically characterized by the elimination of the opposition, prolific use of the death penalty or long prison terms of his political opponents and evictions from homes where their families lived and their internment in remote villages that were strictly controlled by police and the secret police (Sigurimi). Also his rule was characterized by Stalinist methods to destroy his associates, who threatened his own power, economically during his period Albania became industrialised and saw rapid economic growth, as well as unprecedented progress in the areas of education and health. He focused on rebuilding the country which was left in ruins after World War II, building Albania's first railway line, eliminating illiteracy from adult population and leading to Albania becoming agriculturally self-sufficient.
Hoxha's government was characterized by his proclaimed firm adherence to anti-revisionist Marxism–Leninism from the mid-1970s onwards. After his break with Maoism in the 1976–1978 period, numerous Maoist parties declared themselves Hoxhaist. The International Conference of Marxist–Leninist Parties and Organizations (Unity & Struggle) is the most known collection of these parties today.
Hoxha forced out all religion in Albania and is currently the only state ever to be identified as an atheist nation in Europe. He murdered many people in the country, which still has scars from his rule that will last forever. Bodies can still be found in rural towns from his multiple massacres. Albania is now a mostly Muslim country, though little has been known about the country for many years.
A new Constitution was decided upon by the Seventh Congress of the Albanian Party of Labour on 1–7 November 1976. According to Hoxha, "The old Constitution was the Constitution of the building of the foundations of socialism, whereas the new Constitution will be the Constitution of the complete construction of a socialist society."
Self-reliance was now stressed more than ever. Citizens were encouraged to train in the use of weapons, and this activity was also taught in schools. This was to encourage the creation of quick partisans.
Borrowing and foreign investment were banned under Article 26 of the Constitution, which read: "The granting of concessions to, and the creation of foreign economic and financial companies and other institutions or ones formed jointly with bourgeois and revisionist capitalist monopolies and states as well as obtaining credits from them are prohibited in the People's Socialist Republic of Albania." No country whatsoever, big or small, can build socialism by taking credits and aid from the bourgeoisie and the revisionists or by integrating its economy into the world system of capitalist economies. Any such linking of the economy of a socialist country with the economy of bourgeois or revisionist countries opens the doors to the actions of the economic laws of capitalism and the degeneration of the socialist order. This is the road of betrayal and the restoration of capitalism, which the revisionist cliques have pursued and are pursuing.—Enver HoxhaAlbania was very poor and backward by European standards and it had the lowest standard of living in Europe. As a result of economic self-sufficiency, Albania had a minimal foreign debt. In 1983, Albania imported goods worth $280 million but exported goods worth $290 million, producing a trade surplus of $10 million.
In 1981, Hoxha ordered the execution of several party and government officials in a new purge. Prime Minister Mehmet Shehu, the second-most powerful man in Albania and Hoxha's closest comrade-in-arms for 40 years, was reported to have committed suicide in December 1981. He was subsequently condemned as a "traitor" to Albania, and was also accused of operating in the service of multiple intelligence agencies. It is generally believed that he was either killed or shot himself during a power struggle or over differing foreign policy matters with Hoxha. Hoxha also wrote a large assortment of books during this period, resulting in over 65 volumes of collected works, condensed into six volumes of selected works.
Hoxha suffered a heart attack in 1973 from which he never fully recovered. In increasingly precarious health from the late 1970s onward, he turned most state functions over to Ramiz Alia. In his final days he was a wheelchair user and was suffering from diabetes, which he had suffered from since 1948, and cerebral ischemia, which he had suffered from since 1983. On 9 April 1985, he suffered a massive ventricular fibrillation. All efforts to reverse it failed, and he died earl on the morning of 11 April 1985.
Hoxha's death left Albania with a legacy of isolation and fear of the outside world. Despite some economic progress made by Hoxha, the country was in economic stagnation; Albania had been the poorest European country throughout much of the Cold War period. Following the transition to democracy in 1992, Hoxha's legacy diminished, so that by the early 21st century very little of it was still in place in Albania.