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Alcohol Shakes and Tremors

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What are Alcohol Shakes (Tremors)?

When someone is struggling with chronic or long-term alcohol dependence, 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.

Tremors happen when alcohol leaves the bloodstream of a heavy drinker. Here, the nervous system becomes hyperactive, resulting in irregular muscular movement. 

While tremors aren’t life-threatening, they can be embarrassing or signal a bigger problem. Those experiencing alcohol shakes may be unable to perform everyday tasks and functions.

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3 Causes of Alcohol Shakes and Tremors

Alcohol shakes and tremors can be hangover symptoms but are usually caused by dehydration, not alcohol withdrawal.

There are three main causes of alcohol shakes:

1. Alcohol Withdrawal Symptoms

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

In heavier drinkers, the brain releases more excitatory neurotransmitters than usual when responding to the sedative effects of alcohol. This increases nerve activity to keep their bodies more alert and awake. 

These adjustments in brain chemistry are partly why those experiencing high alcohol tolerance often don’t seem drunk.

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

Symptoms of alcohol withdrawal include:

  • Body tremors
  • Anxiety or depression
  • Sweating
  • Hyperactivity
  • An increased heart rate
  • Nausea
  • Vomiting

Some people can develop severe symptoms of alcohol withdrawal called delirium tremens (DTs). This condition can result in severe shaking or shivering.

Additional symptoms and side effects of delirium tremens include:

  • Hallucinations
  • Agitation
  • High blood pressure
  • Fever
  • Seizures

Delirium tremens symptoms can be fatal. Therefore, most people experiencing DTs should detox from alcohol in a medically monitored facility.

In addition, mental health disorders, such as anxiety, stress, and depression, can increase the severity of alcohol withdrawal symptoms like tremors. 

2. Liver Disease

Alcohol use disorder may also lead to liver disease

Liver disease can lead to abnormal ammonia metabolism. This can lead to asterixis, which causes hands to flap or shake uncontrollably.

Prolonged liver disease results in several risks and complications. This includes a potentially fatal brain condition called hepatic encephalopathy

Hepatic encephalopathy develops when the liver cannot filter toxins from the blood that affect the brain cells. Nicknamed the ‘liver flap,’ this tremor is often compared to a bird flapping its wings and look similar to symptoms of Parkinson’s disease.

These unfiltered 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

3. Alcohol-Induced Brain Damage

Alcohol addiction that involves frequent and excessive drinking can also affect the cerebellum

The cerebellum is a part of the brain found near the top of the brain stem. It maintains balance, coordination, and fine motor movement.

Damage to the cerebellum caused by alcohol can lead to an intention tremor. This specific type of trembling is most noticeable when someone makes a purposeful move towards an item or object. 

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 10 years to develop.

the health effects of alcohol

Once symptoms and side effects of alcohol-linked brain damage develop, they usually worsen if alcohol substance use continues. These damages may become irreversible, even if the person stops drinking alcohol.

Symptoms and Signs of Alcohol Shakes

There are more than 20 types of alcohol tremors. Alcohol shakes are diagnosed based on a person’s medical history and a physical and neurological examination.

Depending on the alcohol disorder's severity, withdrawal symptoms may begin around 5 to 10 hours after the last drink or sooner. Withdrawal symptoms usually peak 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
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Treatment for Alcohol Shakes and Tremors

Treatment for alcohol shakes and tremors depends on the severity of alcohol use. While some people can independently rid themselves of the shakes, others may need medical intervention.

Lifestyle Changes

Those experiencing alcohol withdrawal who do not need medical detoxing should keep busy with activities, hobbies, and promote their 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 upbeat TV shows or movies 
  • Listening to motivational speakers 
  • Spending time with 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 
  • Avoiding sugary foods and drink 
  • Drinking plenty of water

If you or someone you know is experiencing alcohol shakes, seek medical advice from a qualified healthcare provider.

Detoxing

For most people with alcoholism, medical detoxing is the first step in sobering up. However, for many, quitting ‘cold turkey’ can be dangerous. 

Severe complications, such as withdrawal seizures, can occur. For this reason, detoxing 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 health factors. A treatment program may also include prescription medicine to help with alcohol addiction.

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.

There are two types of treatment facilities that help people detox from alcohol:

1. Residential Treatment

Residential detox treatment, or inpatient treatment, can be short-term, lasting a few months, or long-term, lasting up to a year or longer. 

Inpatient treatment is suitable for those who once attended an inpatient or outpatient program but need continuing medical attention to achieve long-term sobriety.

Residential treatment requires people to live in the facility full time, with around-the-clock supervision. Here, professionals aid people who are detoxing using medications and therapies.

2. Outpatient Treatment

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

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 detox at an inpatient rehab facility or a controlled residential environment like a halfway house or recovery facility.

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Summary

Alcohol shakes can be the result of mild or moderate drinking and dehydration. It can also result from something more serious, like liver disease and addiction. 

If you want to change your relationship with alcohol, speak with a professional to see how you can do it safely and effectively. 

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Updated on September 12, 2022
9 sources cited
  1. MedlinePlus.Tremor fact sheet”. National Institute of Neurological Disorders and Stroke. www.medlineplus.gov, 2020.
  2. National Clinical Guideline Centre, UK. “Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications”. London: Royal College of Physicians (UK). 2010. 
  3. Kattimani, Shivanand, and Balaji Bharadwaj. “Clinical management of alcohol withdrawal: A systematic review”. Industrial psychiatry journal vol. 22,2. 2013.
  4. Hugh Myrick, M.D., and Raymond F. Anton, M.D. “Treatment of alcohol withdrawal”. Alcohol health & research world. 1998.
  5. Rahman A, Paul M. “Delirium Tremens (DT)”. StatPearls Publishing. 2020.
  6. MedlinePlus. “Alcohol withdrawal”. www.MedlinePlus.gov. 2020.
  7. NIDA. “Principles of Effective Treatment”. www.Nida.nih.gov. January 2018.
  8. Dhiman RK, Chawla YK. “Herbal medicines for liver diseases”. Dig Dis Sci. 2005. 
  9. Jones EA, Weissenborn K. “Neurology and the liverJournal of Neurology”. Neurosurgery & Psychiatry. 1997.

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