Alcohol & Health
Treatment
Helping Alcoholics
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Medically Reviewed by Dr P. E. Pancoast, MD
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.
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 Shakes and Tremors can be a symptom of a hangover but are usually caused by dehydration during a hangover, not alcohol withdrawal.
There are various causes of alcohol shakes:
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 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 individual experiences symptoms of withdrawal.
Symptoms of alcohol withdrawal include:
Some people can develop a severe type of alcohol withdrawal called delirium tremens (DTs). 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.
Alcohol use disorder can also lead to liver disease. In its advanced stages, liver disease can lead to abnormal ammonia metabolism. This involves flapping or shaking of the hands and is 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:
Nicknamed the ‘liver flap,’ this tremor is often compared to a bird flapping its wings. Some people suffering from liver disease may also experience tremors similar to the shakes that individuals with Parkinson’s disease have.
Unrelated progressive hepatic encephalopathy can result in coma, irreversible brain damage, or death. However, alcohol abstinence and medical care can usually help reverse the disease.
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:
Some people also damage their peripheral nervous system with excessive alcohol consumption. This can lead to:
Alcohol-related damage to the cerebellum usually takes around 10 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 usually worsen if alcohol substance use continues. These damages may become irreversible, even if the person completely stops drinking alcohol.
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:
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:
If you or someone you know is experiencing alcohol shakes, seek medical advice from a qualified healthcare provider.
For most people with alcoholism, medical detoxing is the first step in sobering up. For those with a high level of alcoholism, quitting ‘cold turkey’ can be dangerous. Severe complications, such as withdrawal seizures, can occur.
For that reason, sometimes weaning off of alcohol is recommended.
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 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 attention to achieve long-term sobriety.
During outpatient treatment detox, 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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