Alcohol tremors, also sometimes known as alcohol shakes, are a distressing but common symptom of alcohol withdrawal. They are involuntary muscle movements that may be disturbing and uncomfortable and signal an underlying issue related to alcohol dependence. Alcohol tremors usually affect the hands, but also may occur in other body parts, such as the arms, legs, and head.
The seriousness of the tremors can vary from mild trembling to severe shakiness that might interfere with day-to-day activities.
What Causes Alcohol Tremors?
Alcohol tremors occur because the body has become dependent on alcohol and reacts when there is an absence of it. It works like this:
CNS Imbalance
Chronic consumption of alcohol affects the levels of neurotransmitters in the brain and central nervous system (CNS). The CNS becomes accustomed to the depressant effects of alcohol and has to work harder to overcome the depressant to keep the body functioning. When the alcohol is suddenly removed, the CNS becomes imbalanced and can’t regulate itself quickly enough. It then becomes hyperactive because there isn’t any more alcohol to slow it down. This overload of activity is displayed as tremors along with other withdrawal symptoms.
Withdrawal Symptoms
Alcohol tremors are part of a larger array of alcohol withdrawal symptoms. Withdrawal symptoms typically begin within 6 to 24 hours after the last consumption and may last for several days. Symptoms tend to peak at 24 to 72 hours. Withdrawal symptoms include:
- Headache
- Anxiety
- Sleep problems
- Extreme sweating
- Stomach distress
- Heart palpitations (irregular, fast, or pounding heartbeat)
- Increased blood pressure
- High body temperature
- Tremors
- Confusion
- Hallucinations
- Seizures
- Delirium Tremens (the most severe form of alcohol withdrawal, also characterized by a coarse tremor and signs of heightened involuntary muscle activity, often with delusions or hallucinations)
Types of Tremors Associated with Alcohol Use
Alcohol tremors are frequently linked to delirium tremens (DTs). Other signs of alcohol-related cerebellar dysfunction include clumsiness, loss of balance and coordination, unsteady walking, and involuntary back-and-forth eye movements known as nystagmus.
Alcohol use can lead to various kinds of tremors including:
Action Tremors
These tremors usually occur in the hands or head but can also affect the face, trunk, and voice. They are an involuntary, shaking pattern during voluntary muscle movements such as lifting an item or writing. Action tremors can be caused by alcohol and drug withdrawal, among several other neurological disorders. Besides alcohol and drug withdrawal, other causes may be several brain disorders and lithium toxicity.
Postural Tremors
This is the most common type of alcohol tremor. It is an involuntary shaking of a body part when the person tries to hold a position against gravity such as when the person holds their arms out in front of them. Postural tremors are seen most often in the upper limbs. It may occur in both advanced alcohol dependence and early withdrawal. Other causes include brain lesions, metabolic issues, and neurodegenerative disorders.
Flapping Tremors
Flapping tremors (also known as “asterixis”) occur in advanced cases of alcoholic liver disease and are an ominous sign of impending liver disease. They are a type of involuntary muscle movement that involves an unexpected loss of muscle contractions. The interruptions of voluntary muscle actions where the person can’t hold a sustained posture, lead to involuntary jerking movements that resemble a bird flapping its wings.
These tremors are usually associated with severe liver disease and may be a sign of hepatic encephalopathy (a brain dysfunction brought on by the failure of the liver to filter toxins from the blood). Other possible causes include infections, drug toxicity, and metabolic disorders. Treatment for flapping tremors depends on the underlying cause.
How Long Do Alcohol Tremors Last?
Alcohol tremors usually diminish within a few days to a week after the last drink. However, in severe cases, tremors may last for 10 days. About 5% of hospitalized AUD patients suffer from delirium tremens (DT). Usually, DT appears on the 3rd to 5th day after quitting drinking and lasts about 24 hours to 6 days but may last for weeks in rare circumstances.
What’s the Connection Between Alcohol Withdrawal and Tremors?
Alcohol tremors are the consequence of withdrawal in people who are physically dependent on alcohol. The amount of alcohol necessary to cause tremors is different for each person. It depends on:
- How long they have been drinking
- How much they drink regularly
- The person’s body chemistry
- Whether other substances are being used
- The presence of other health issues
Because chronic alcohol use alters how the neurotransmitters in the brain operate, the brain alters the production of neurotransmitters. When the person stops drinking, neurotransmitters such as glutamate and Gamma-Amino-Butyric Acid (GABA) are out of balance which leads to withdrawal symptoms like tremors. It can also lead to other withdrawal symptoms and more serious withdrawal consequences.
Health Risks Associated with Alcohol Tremors
In most cases, alcohol tremors aren’t dangerous. They may appear in the morning after drinking and then disappear. They may be caused by poor nutrition, dehydration, and muscle and nerve hyperactivity after being depressed by alcohol.
Still, this symptom can indicate more serious issues, particularly if they are present when not going through withdrawal. Health-related issues include:
Brain Damage
Tremors may occur separately from withdrawal if AUD has caused brain damage. Heavy drinking affects the cerebellum–the part of the brain responsible for motor functions. Besides the tremors, this damage causes:
- a loss of coordination and balance,
- muscle weakness, and
- numbness.
Liver Disease
Advanced liver disease can lead to shaky hands. This occurs when the disease progresses to cause a brain disorder caused by hepatic encephalopathy. The build-up of toxins in the brain results in:
- mood swings,
- motor control issues, and
- flapping tremors.
Wernicke-Korsakoff Syndrome (WKS)
Tremors may be a symptom of this neurological disorder. Also known as “wet brain,” it happens when alcohol use has caused a thiamine deficiency. Without treatment, Wernicke’s will cause:
- mental decline,
- loss of memory function, and
- death.
Diagnosing Alcohol Tremors: When to Seek Help
It’s important to recognize the dangers of tremors to know when to seek medical help for alcohol-related tremors. Since alcohol tremors may be a sign of Wernicke-Korsakoff Syndrome, it’s crucial to see your healthcare provider immediately. There are many methods to treat alcohol tremors.
Treatment Options for Alcohol Tremors
The first step in treatment is most likely to be an alcohol detox in a professional treatment center. Quitting “cold turkey” can lead to life-threatening withdrawal symptoms and complications. In the detox center, medications may be used to control tremors and other withdrawal symptoms. Medications include:
- Benzodiazepines to manage withdrawal symptoms, including tremors
- Thiamine to reduce the risk of developing WKS and decrease tremors
- Propranolol, a beta-blocker that reduces tremors
Can Alcohol Tremors Be Prevented?
Getting treatment for alcohol dependence early can be extremely important for preventing the tremors and other symptoms that come from alcohol withdrawal.
Coping with Alcohol Tremors During Recovery
Anxiety and stress can increase the severity of alcohol withdrawal symptoms. Some activities can help promote health and well-being such as:
- Begin or return to a hobby
- Participate in exercise like biking or walking
- Practice yoga or meditation
- Listen to motivational speakers
- Spend time with motivational speakers
- Eat a diet high in lean protein, whole grains, fruits, and vegetables
- Associate with trustworthy positive people
- Drink lots of water and avoid sugar
- Ask your healthcare provider to recommend supplements that might help
The Importance of Medical Support for Alcohol-Related Tremors
- DTs
- changes in the person’s mental status,
- hallucinations,
- delusions, and
- regulating involuntary body functions such as heart rate, body temperature, and blood pressure.
- WKS
- Liver Disease
- Neurological and Metabolic Disorders
Seeking Help for Alcohol Dependence and Withdrawal Symptoms
If you or your loved one is experiencing alcohol withdrawal tremors, there is a problem with AUD and that can be effectively treated at Agape Treatment Center in Fort Lauderdale, FL. We can provide a range of treatment options so you have more flexibility in designing your treatment regimen. Here is just some of what Agape can offer you:
- Partial Hospitalization Program (PHP)–technically an outpatient program, its intensity is closer to an inpatient or residential program although you do not reside at the facility full-time.
- Intensive Outpatient Program (IOP)– requires less time at the treatment facility and is excellent for people with mild to moderate addiction.
- Outpatient Program (OP)– requires fewer hours of treatment and is a good way to continue treatment after completing a higher level of care
- Medication-Assisted Treatment–to assist in easing tremors and withdrawal symptoms
- Nutrition Education
- Veteran’s Rehab–a program for veterans only because it’s easier to open up in a group of peers
- Mental health treatment/Dual diagnosis program
Agape can help you with individualized treatment. Our skilled and experienced therapists and healthcare professionals have one job–your success. Contact us today.
Stephanie Robilio is an accomplished Clinical Director at Agape Behavioral Healthcare. With a Master of Social Work degree, LCSW license, and extensive training in Rapid Resolution Therapy under her belt, she brings a wealth of expertise to her role. Her unique combination of education and experience allows her to provide exceptional care to clients and lead her team with confidence. Stephanie’s joy comes from witnessing the moments when her patients creatively connect the dots and bravely move toward reclaiming their power. Her purpose is to help individuals understand their past so they can create a future full of hope, growth, and success. Stephanie attributes a large portion of her success to the supportive culture and strong sense of community fostered by the Agape team.
