Alcohol Shakes & Tremors: Causes & What to Do

Alcohol shakes and tremors are terms that are often used interchangeably, but the terms can mean different things depending on the cause. In all cases, however, the issue generally means that treatment for alcohol use disorder (AUD) is needed. 

The specifics of treatment will be based on the cause of the shakes or tremors, and it will likely be different for each person. Depending on the severity and the cause, treatment should help the individual manage their AUD successfully, though it may take time to find the right solution. 

What Are Alcohol Shakes & Tremors?

Alcohol shakes or tremors are defined as shaking that occurs in the limbs when someone who is physically dependent on alcohol is without alcohol for a period or drinks less than usual. These tremors can be mild to moderate in nature.[1] 

For some living with an active AUD, the shakes may occur first thing in the morning before the first drink because levels of alcohol are at their lowest. 

It is important to note that not all shaking or tremors are due to alcohol withdrawal. In the absence of alcohol misuse and AUD, tremors can be caused by neurological issues, thyroid disorder, liver or kidney failure, diabetes, heavy metals, medications or other issues.[2] 

Differentiating Between Shakes & Tremors

When it comes to alcohol withdrawal, the shakes are generally considered to be more mild than tremors. They can occur at any time that blood alcohol levels drop in a person who is used to drinking heavily regularly.

Tremors are more pronounced, starting as “the shakes” and progressing to a severe tremor if the person does not drink. In some cases, it may be possible for someone living with an active AUD to experience tremors even when they are drinking. This may be due to a co-occurring issue, such as liver failure or diabetes, and not just the alcohol level.[2] 

Causes of Alcohol Shakes & Tremors

Alcohol shakes and tremors usually occur during alcohol detox and are defined as an alcohol withdrawal symptom. Essentially, over time, the body adjusts its processes in the central nervous system to expect a certain level of alcohol in the system at all times. That is, neurotransmitter levels adjust based on the impact of alcohol, and the communication between cells is altered as well.[1] 

When the usual level of alcohol drops, it takes time for the body to adjust its functioning to exclude the presence of alcohol, and this period is called alcohol withdrawal. One of the symptoms of this process is alcohol shakes, which can progress into alcohol tremors if untreated.[1]

It’s important to note that not everyone’s experience with alcohol withdrawal, or alcohol shakes and tremors, will be the same. Some people may not experience the issue at all or have only a mild issue despite having a similar alcohol problem as someone who experiences extreme tremors when their alcohol levels drop.

Just like family history can impact whether or not AUD develops after exposure to alcohol use, genetics can also play a role due to the differences that can occur in serotonin receptors and serotonin transporters.[3] 

Symptoms & Effects

Alcohol shakes generally manifest as a light shaking of the hands or shivering in the body. In some cases, it may co-occur with agitation and irritability or feeling unsettled physically and mentally. 

If the alcohol shakes progress to a tremor, it is not uncommon to experience muscle spasms and extreme anxiety in addition to other symptoms of withdrawal. In fact, alcohol shakes generally do not occur on their own. Rather, they are usually just one of many symptoms of withdrawal that begin within eight hours of ingesting the last drink and peak between 24 and 72 hours.[4] 

For many people, this experience comes with a range of symptoms that can include the following:[4]

• Mood swings
• Nightmares and restless sleep or inability to sleep
• Depression
• Fatigue
• Nausea and vomiting 
• Sweating and clammy skin 
• Headache 
• Fuzzy thinking
• Rapid heart rate
• Lack of appetite 

Who Is at Risk?

Alcohol is a central nervous system depressant. Repeated exposure at high doses causes the body to inhibit the glutamate receptors and enhance signaling through the GABA receptors. When alcohol is removed, the inhibition of glutamate stops, and the body is overwhelmed by the glutamate response, triggering hyperexcitability in the nervous system and ultimately withdrawal symptoms.[5]

The higher the dose of alcohol and the more frequently that alcohol is ingested, the greater this disruption will be. This makes it more likely that someone will experience alcohol shakes and tremors. 

Treatment Options

It is important to seek treatment for alcohol withdrawal symptoms, especially if alcohol tremors turn into delirium tremens (DTs). This is an extreme form of withdrawal characterized by extreme confusion, hallucinations, and seizures, and it has the potential to be deadly.[5] 

There are a number of possibilities for treatment, depending on how withdrawal symptoms are manifesting, whether or not the person would like to detox fully from alcohol, and how serious the physical and mental response to symptoms is. 

Symptom Maintenance

In some cases, if symptoms are mild, the individual experiencing alcohol withdrawal symptoms may need nothing more than symptom management. Depending on the specific symptoms they are experiencing, different courses of action may help to make them feel more comfortable as they get through detox. For example, anti-anxiety medications or treatments for insomnia may be prescribed.

Tapering 

It may be appropriate at high levels of alcohol intake to undertake an alcohol tapering program overseen by a doctor in which the levels of alcohol are lowered slowly over time in order to stave off a sudden onset of life-threatening symptoms.[6] It is incredibly difficult to monitor this process on your own without help, as relapse is likely.

Medications for Alcohol Withdrawal

Depending on the severity of symptoms and the goals for treatment, there are a number of medications that may be prescribed during alcohol withdrawal. In order to increase comfort, a patient may be prescribed benzodiazepines during the worst of the symptoms to avoid severe withdrawal and delirium tremens. For long-term maintenance in recovery, it may be appropriate to prescribe medications designed to deter relapse like naltrexone.[6]

Full-Spectrum Treatment Recommended 

No matter which treatment occurs during alcohol withdrawal, it is important to stick with therapy, medications when appropriate, and ongoing medical and psychological support during recovery. For some, the full treatment process lasts months, while others stay connected to the recovery community for years or a lifetime. 

Behavioral Therapies

Cognitive behavioral therapy, dialectical behavior therapy, and other therapies that focus on behavior modification can help people in recovery from AUD to manage mood, stress and compulsivity in recovery. 

While people who experience alcohol withdrawal symptoms will require medical care and supervision, engaging with therapists and support groups to manage challenges, adjust perspective and address co-occurring mental health disorders can provide the ongoing support needed to create positive lifestyle changes that will help sustain sobriety. 

Self-Help & Coping Strategies

If you are experiencing alcohol shakes and tremors, you can help manage the issue with some healthy coping strategies, including these: 

• Healthy nutrition: Though your appetite may drop during alcohol detox, make sure to eat healthy foods like fruits and vegetables and simple soups. Avoid processed foods and sugar. 

• Hydration: Staying hydrated can help to keep symptoms like headaches from worsening and keep you feeling more comfortable, especially if you are struggling with nausea and vomiting. 

• Relaxation techniques: Agitation, anxiety and depression can all play a role in alcohol withdrawal symptoms. It can be helpful to engage in slow, deep breathing and listen to a guided meditation or soft music. 

• Good rest: Sleep doesn’t always come easily during alcohol withdrawal, but try to rest in order to give your body as much support as possible while it heals. 

When to Seek Help

If you are attempting to stop drinking at home, monitor your symptoms to ensure that you connect with medical treatment immediately if they become severe. The reported mortality rate for DTs is between 1% and 5%, so it is essential to head to the emergency room if you are experiencing severe issues.[5]

If alcohol shakes turn into tremors and co-occur with serious symptoms such as fever, delirium, stupor or seizures, seek help immediately.[7]

In Summary

Alcohol shakes and tremors generally occur during alcohol withdrawal, as the body adjusts to having less or no alcohol in the system. A light shaking or shivering characterizes alcohol shakes, while tremors are usually a bit more pronounced. 

Treatments are available to minimize alcohol shakes and tremors as well as manage co-occurring withdrawal symptoms. If symptoms appear, persist or worsen, contact emergency medical help immediately.