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Understanding Alcohol Shakes and Tremors and What To Do About Them

Medically reviewed by Dr. Po-Chang HsuJuly 15, 2024
Written by
On July 15, 2024

Table of Contents

Key Points

  • Alcohol shakes or tremors are a common symptom of alcohol withdrawal.
  • While symptoms are often mild and can be managed at home, severe alcohol withdrawal symptoms can be life-threatening and require medical interventions.
  • Tremors can pass in a few days, or they may be an indication of more severe health conditions due to drinking alcohol.

Understanding Alcohol Shakes and Tremors

Alcohol shakes, also known as tremors, are often a result of stopping excessive alcohol consumption. For most people, these shakes will pass in a few days; however, for some, they can last for weeks and may indicate more severe health conditions due to heavy drinking.

Causes of Alcohol Withdrawal

Alcohol is a central nervous system (CNS) depressant.[1] When your body is dependent on alcohol due to long-term use, when you stop drinking, the CNS becomes over-excited as you have taken away the depressant. Your body responds by going into excitatory overload, resulting in withdrawal symptoms. 

Alcohol withdrawal has a wide range of symptoms, from mild, which can be treated at home, to severe, which require medical attention and can be life-threatening. Alcohol withdrawal symptoms can worsen in severity the more often you go through the withdrawal process.[2] The more withdrawal episodes you experience, the more sensitive you are to experience symptoms, particularly those of seizures. If you have already experienced an alcohol withdrawal seizure, you are at a higher risk of experiencing another one during alcohol withdrawal.

Alcohol Withdrawal Symptoms

Alcohol withdrawal occurs when a person who regularly drinks too much alcohol abruptly stops drinking. Withdrawal symptoms usually start within eight hours of your last drink, peak at 24-72 hours, and last for a few days beyond that, although some people do experience symptoms for a few weeks. Common symptoms of alcohol withdrawal include:[3]

  • Alcohol cravings
  • Nausea, vomiting, stomach pain
  • Anxiety or depression
  • Nervousness or jumpiness
  • Mood swings and irritability
  • Fatigue
  • Difficulty thinking clearly
  • Nightmares

Additional signs of alcohol withdrawal include [4]

  • Puffy and blotchy skin
  • Sweating and clammy skin
  • Swelling in your extremities
  • Headache
  • Dilated pupils
  • Insomnia
  • Rapid heart rate, high blood pressure
  • Tremors, most often in hands but can be in other body parts

Severity of Alcohol Shakes, Tremors, and Seizures

The duration and severity of your alcohol withdrawal symptoms vary from person to person based on genetics, the amount of alcohol consumed, the process you use to stop drinking, and the treatment and support you receive through your withdrawal process. 

Alcohol shakes and tremors can be mild tremors experienced in the fingers and hands to more extreme and life-threatening seizures.

Tremors

Tremors, also known as alcohol shakes, are a common symptom of alcohol withdrawal. They can be mild, with barely perceivable quivering in one’s hands, to more severe, where it is difficult to hold anything in your hands.

Tremors occur during alcohol withdrawal because alcohol is a central nervous system depressant. When it is suddenly removed, the nervous system becomes hyperactive due to an imbalance in neurotransmitters such as GABA and glutamate. When the alcohol is removed from your system, it struggles to adjust to no longer having the depressant. Your nervous system becomes over-excited due to an imbalance in your GABA and glutamate neurotransmitters.[5] This hyperactivity and imbalance can cause tremors.

Tonic-Clonic Seizure

Tonic-clonic seizures develop 12-24 hours after you have stopped drinking.[6] This two-stage seizure starts with the tonic phase, where you experience sudden muscle contractions that usually lead to a fall and loss of consciousness. The spasm lasts 10-30 seconds but can be so strong it forces the air out of your lungs, causing you to moan or even scream. You will then transition into the clonic phase, which lasts 1-2 minutes. In this phase, you experience rapid, intense, and rhythmic muscle contractions throughout your body, often leading to bladder and bowel control loss. Once the seizure ends, your body will relax, begin breathing normally, and regain consciousness.

If you experience a tonic-clonic seizure, you should speak to your medical provider as soon as possible. They may recommend you complete medical alcohol detox to prevent any further complications of withdrawal.

Delirium Tremens

If you have an alcohol withdrawal seizure, you are at an increased risk for experiencing delirium tremens (DTs). Delirium Tremens is the most severe level of alcohol withdrawal. It starts 48-96 hours after your last drink and lasts seven to ten days. It is necessary to seek immediate medical attention if you experience DT symptoms, as it can be fatal. Delirium tremens symptoms include:[7]

  • Mood swings, agitation, irritability
  • Body tremors
  • Changes in mental function
  • Deep sleep over an extended period
  • Delirium – sudden, severe confusion
  • Excitement or fear
  • Fever
  • Hallucinations – seeing or feeling things that are not there
  • Bursts of energy
  • Restlessness
  • Sensitivity to light, sound, touch
  • Fatigue
  • Insomnia

The treatment focus is on saving the person’s life and minimizing any further complications of withdrawal.

Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff syndrome is a neurological condition due to a lack of thiamine (vitamin B1). One of the causes of Wernicke-Korsakoff syndrome is alcohol abuse. Alcohol causes a vitamin B1 deficiency that damages the thalamus and hypothalamus in the brain. Wernicke-Korsakoff syndrome characteristics are problems acquiring new information, establishing new memories, and retrieving old memories. Symptoms include vision problems, disorientation, amnesia, tremors, and coma.[8]

Treatment involves replacing vitamin B1, proper nutrition, and hydration (water and electrolytes). Certain medication treatments may help stop alcohol use to prevent further nerve and brain damage. Many symptoms can be reversed with treatment, but memory function takes time to return. Without treatment, Wernicke-Korsakoff syndrome can be life-threatening.

Alcohol Use Disorder Treatment and Withdrawal Management

The severity of your withdrawal symptoms will determine the type of treatment you need. Mild symptoms may be manageable at home with outpatient support, while more severe symptoms may require medical inpatient detox.

Mild symptoms of withdrawal can typically be treated at home. To treat symptoms of sweating and diarrhea, you should drink plenty of fluids and take over-the-counter medications as needed for symptom management.[9]

Moderate symptoms may be managed at home but should be discussed with your healthcare provider. Your medical provider may prescribe a benzodiazepine to help reduce the intensity of your alcohol withdrawal symptoms.[10] They may also create a plan with you to determine at what level of symptom severity you should seek more intensive medical treatment.

Severe symptoms require medical attention; do not attempt to manage your severe alcohol withdrawal symptoms alone at home. Severe symptoms require medical interventions such as high doses of benzodiazepines, other supportive medications, treatments such as IV fluids, and possibly life-saving measures, depending on the severity of your symptoms.[11]

When to Seek Medical Help

Alcohol withdrawal is a serious and potentially life-threatening condition. If you believe you are experiencing alcohol withdrawal, contact your healthcare provider or go to the closest emergency department. If you experience a seizure, extreme confusion, hallucinations, or an irregular heartbeat, call 911. When you seek medical attention, be honest with the providers about your alcohol consumption so they can properly treat you for alcohol withdrawal.

The Prognosis of Alcohol Shakes and Tremors

How well you do after experiencing withdrawal symptoms depends on whether you continue unhealthy alcohol use or not. Repeating the withdrawal process increases your risks of more severe withdrawal symptoms each time and increases your risk for seizures. Seeking treatment at an alcohol rehab will increase your chances of staying sober and repairing your body from the damage alcohol use disorder has caused.

Medical Content Writer

Amanda Stevens is a highly respected figure in the field of medical content writing, with a specific focus on eating disorders and addiction treatment. Amanda earned a Bachelor of Science degree in Social Work from Purdue University, graduating Magna Cum Laude, which serves as a strong educational foundation for her contributions.

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Frequently Asked Questions About Alcohol Shakes

Alcohol withdrawal symptoms of tremors or shakes usually last 12-48 hours. However, if you experience more severe symptoms, they may last 7-10 days.[12]

Depending on your symptoms, you may need to seek emergency medical treatment. They will be able to give you high doses of medications to reduce the severity of your alcohol withdrawal symptoms. Should you have more severe complications, they can provide the necessary interventions.

Alcohol shakes are more serious than a hangover and may not respond to typical treatments of over-the-counter medications, increased hydration, and improved nutrition. If you have alcohol shakes, you should talk to your healthcare provider. They may prescribe medications to treat your symptoms, and they can help you seek more long-term addiction treatment to prevent your alcohol shakes and withdrawal symptoms from happening again.

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[1,2,5] Canver, B.R., Newman, R.K., Gomez, A.E. (2024 Feb, 14). Alcohol Withdrawal Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441882/ on 2024, June 27.

[3,4] U.S. National Library of Medicine. (2023, February 28). Alcohol withdrawal: Medlineplus Medical Encyclopedia. MedlinePlus. Retrieved from https://medlineplus.gov/ency/article/000764.htm on 2024, June 27.

[6] Johns Hopkins Medicine (n.d.) Tonic-Clonic (Grand Mal) Seizures. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/tonic-clonic-grand-mal-seizures on 2024, June 27.

[7,12] U.S. National Library of Medicine. (2023, February 2). Delirium tremens: Medlineplus medical encyclopedia. MedlinePlus. Retrieved from https://medlineplus.gov/ency/article/000766.htm on 2024, June 27.

[8] U.S. Department of Health and Human Services. (2023, November 28). Wernicke-Korsakoff syndrome. National Institute of Neurological Disorders and Stroke. Retrieved from https://www.ninds.nih.gov/health-information/disorders/wernicke-korsakoff-syndrome on 2024, June 27.

[9,10,11] Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK310652/ on 2024, June 27.

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