Alcohol Shakes and Tremors

What Are Alcohol Shakes (Tremors)?

When someone is struggling with chronic or long-term alcohol addiction, they may experience tremors. Tremors are also known as alcohol shakes.

Tremors refer to involuntary shaking in one or various areas of the body. Alcohol shakes can occur intermittently, or they can be constant.

Alcohol shakes are caused by an issue in the parts of the brain that controls the body’s muscles. While tremors aren’t life-threatening, they can be embarrassing or inconvenient. Those experiencing alcohol shakes may be unable to perform everyday tasks and functions.

If someone believes they may be experiencing alcohol shakes, they should seek medical care to help them detox and reduce them.

alcohol

Causes of Alcohol Shakes

There are various causes of alcohol shakes:

Alcohol Withdrawal Symptoms

Alcohol is a central nervous system depressant. Alcohol slows brain activity and lessens energy levels. But when someone drinks alcohol regularly, their body adapts to its presence in their system.

To respond to the sedative effects of alcohol, the brain releases more excitatory neurotransmitters than usual. This increases nerve activity to keep the body more alert and awake. These adjustments in brain chemistry are partly why those experiencing alcohol addiction often don’t seem drunk.

However, when someone who experiences alcohol dependence suddenly quits drinking, the brain continues to work as if alcohol were still present in the body. The individual experiences symptoms of alcohol withdrawal

These symptoms and side effects include:

  • Body tremors
  • A mental health disorder such as anxiety or depression
  • Sweating
  • Hyperactivity
  • An increased heart rate
  • Nausea
  • Vomiting

Some people can develop a severe type of alcohol withdrawal called delirium tremens. They occur in about 1 out of every 20 people who have withdrawal symptoms.

This can result in severe shaking or shivering.

Additional symptoms and side effects of delirium tremens include:

Delirium tremens symptoms can be fatal. Most individuals experiencing these severe symptoms should detox from alcohol in a medically monitored facility.

Liver Disease

Alcohol use disorder can also lead to liver disease. In its advanced stages, liver disease can lead to flapping or shaking of the hands known as asterixis.

Prolonged liver disease results in several risks and complications. This includes a potentially fatal brain condition called hepatic encephalopathy. This disease develops when the liver cannot filter toxins that affect the brain cells from the blood. These toxins contain substances, including ammonia, manganese, and more.

When these toxins collect in the brain, the individual starts to experience various symptoms. These include:

  • Disturbed sleep
  • Mood changes
  • Issues with motor control, including a flapping tremor

Nicknamed the ‘liver flap,’ this tremor is often compared to a bird flapping its wings. Some people suffering from liver disease experience tremors similar to the shakes that individuals with Parkinson’s disease have.

Hepatic encephalopathy can result in coma and death. However, usually, the disease cures with treatment.

Alcohol-Induced Brain Damage

Alcohol addiction that involves frequent and excessive drinking can also affect the cerebellum. This is a part of the brain found near the top of the brain stem. The cerebellum maintains balance, coordination, and fine motor movement.

Damage to the cerebellum caused by alcohol can lead to an intention tremor. This is a specific type of trembling. It is most noticeable when someone makes a purposeful move towards an item or object. However, the intention tremor may also be noticed without movement.

Other symptoms and side effects of alcohol-related cerebellar dysfunction include:

  • Poor coordination and balance
  • Clumsiness
  • An unsteady walk
  • Involuntary back-and-forth eye movements (nystagmus)

Some people also damage their peripheral nervous system with excessive alcohol consumption. This can lead to:

  • Muscle weakness
  • Numbness
  • Tingling and burning pain in their extremities (peripheral neuropathy)

Alcohol-related damage to the cerebellum usually takes around ten years to develop. It displays on an MRI as shrinkage in the cerebellum. The disorder is known to be caused by the damaging effects alcohol has on the brain. Nutritional deficiencies that are common in alcoholism can also affect the cerebellum.

Once symptoms and side effects of alcohol-linked brain damage develop, they worsen if alcohol substance use continues.

sleeping difficulties

Diagnosing & Symptoms of Alcohol Shakes

There are more than 20 types of alcohol tremors. Their appearance and source distinguish most. Shakes that link to alcohol abuse or withdrawal include cerebellar tremor and enhanced physiologic tremor.

Alcohol shakes are diagnosed based on a person’s medical history and a physical and neurological examination.

Depending on how severe the alcohol disorder is, withdrawal symptoms may begin around 5 to 10 hours after the last drink, or sooner. Withdrawal symptoms usually peak at approximately 24 to 48 hours after the last sip. They can last for a few weeks.

The symptoms of alcohol shakes include:

  • A rhythmic shaking across the body, typically the hands
  • Difficulty writing or drawing
  • A shaky voice
  • Issues holding and controlling utensils and other objects

How To Reduce Alcohol Tremors in Recovering Alcoholics

Mental health disorders, such as anxiety, stress, and depression, can increase the severity of alcohol withdrawal symptoms like tremors. Doctors don’t know if mental health disorders are caused by alcohol use, or if the alcohol was used for self-medicating the mental health disorder. 

Those experiencing alcohol withdrawal should keep busy with activities and hobbies they find enjoyable, and promote health and well-being. 

Some ideas to help reduce alcohol tremors include:

  • Starting or continuing a hobby
  • Light exercises like walking or biking 
  • Yoga or meditation 
  • Reading 
  • Watching positive or upbeat TV shows or movies 
  • Listening to motivational speakers 
  • Spending time with positive and trusted people 
  • Acupuncture to reduce anxiety and stress 
  • Eating a healthy diet high in lean proteins, whole grains, fruits, and vegetables 
  • Asking a medical professional to suggest vitamins, mineral supplements, and herbs that may be beneficial 
  • Avoid sugary foods and drink 
  • Drinking plenty of water
treatment

Detox Treatment Options for Alcoholism

For most people with alcoholism, medical detox is the first step of treatment. For those with a high level of alcoholism, quitting ‘cold turkey’ can be dangerous. Severe complications, such as withdrawal seizures, can occur.

Detox with medical supervision may be necessary to keep a person safe and comfortable during alcohol withdrawal.

The type of detox addiction treatment or level of intensity needed depends on the severity of alcohol use and other factors. A treatment program may also include prescription medicine to help with alcohol addiction too.

Once detox is complete, most people will need further help to maintain abstinence long-term. This can come in the form of treatments like therapy or support groups.

Residential Treatment

Residential detox treatment can be short-term, lasting a few months, or long-term lasting up to a year or longer. Residential detox usually involves inpatient treatment. It is suitable for those who once attended an inpatient or outpatient program, but need continuing medical supervision to achieve long-term sobriety.

Outpatient Treatment

During outpatient treatment detox, patients meet medical care members for a few hours at a time, usually around two to three times a week.

However, those following outpatient treatments continue living at home.

Outpatient detoxification may be the first stage of treatment for someone with a less severe substance abuse condition. However, it could be the second stage of treatment for someone who has completed alcohol addiction detox at an inpatient facility.

Resources

Tremor, MedlinePlus, 2016, https://medlineplus.gov/tremor.html

Tremor fact sheet, National Institute of Neurological Disorders and Stroke, 2020, https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet

Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications, National Clinical Guideline Centre, London: Royal College of Physicians (UK); 2010, https://www.ncbi.nlm.nih.gov/books/NBK65581/ 

Kattimani, Shivanand, and Balaji Bharadwaj., Clinical management of alcohol withdrawal: A systematic review., Industrial psychiatry journal vol. 22,2, 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085800/

Treatment of alcohol withdrawal, Alcohol health & research world, 1998, https://pubs.niaaa.nih.gov/publications/arh22-1/38-43.pdf

Rahman A, Paul M., Delirium Tremens (DT), In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020, https://www.ncbi.nlm.nih.gov/books/NBK482134/ 

Alcohol withdrawal, MedlinePlus, 2020, https://medlineplus.gov/ency/article/000764.htm

Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) Principles of Effective Treatment, National institute on drug abuse, 2018, https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment

Dhiman RK, Chawla YK., Herbal medicines for liver diseases. Dig Dis Sci. 2005;50(10):1807-1812, https://pubmed.ncbi.nlm.nih.gov/16187178/

Jones EA, Weissenborn KNeurology and the liverJournal of Neurology, Neurosurgery & Psychiatry 1997;63:279-293, https://jnnp.bmj.com/content/63/3/279.citation-tools

Updated on: September 22, 2020
Author
Ellie Swain
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Medically Reviewed
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Annamarie Coy,
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