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Alcohol Shakes & Tremors: Causes & What to Do

July 6, 2022

Table of Contents

Long-time alcohol misuse can cause shakes and tremors. A foundational study on the issue was published in 1985, and there, researchers said close to half of people with alcoholism had a tremor.[1]

Some alcohol shakes are temporary and will fade with abstinence. But others may be irreversible particularly with prolonged use of alcohol.

No matter what caused your shakes, sobriety is critical. Your doctor can use Medication for Addiction Treatment (MAT) to help you stop drinking for good. 

What Causes Alcohol Shakes?

People who drink tend to develop shakes due to one of a few causes, some of which are temporary and some of which can be permanent: 

1. Dehydration

Alcohol intoxication can cause dehydration and electrolyte abnormalities which can cause the sensation of shakiness/tremors. This tends to resolve once the individual rehydrates and eats. 

2. Alcohol Withdrawal 

Tremors and shakiness are common early symptoms of alcohol withdrawal. Some people experience a severe form of alcohol withdrawal called delirium tremens. Minor tremors become full-body seizures accompanied by high blood pressure and hallucinations. This condition can be fatal. If you notice that you develop shakiness or tremors when you do not drink, this can be a very concerning sign of alcohol dependence and one should seek medical attention. 

3. Liver Disease 

Individuals with chronic liver disease from drinking, often called cirrhosis, can have a build up of a chemical called ammonia in the bloodstream, which can cause chronic shaking of the hands. While this symptom can be improved and treated with a medication called Lactulose, it may be a worrisome sign of liver failure and may require lifelong treatment.[3] 

3. Permanent Brain Damage 

Alcohol is toxic to brain cells, and chronic drinkers can develop a much smaller cerebellum. This form of degeneration causes tremors accompanied by an unusual walk, slowed speech, and uncontrolled eye movements.[4] This can be a sign of progressive brain damage from alcohol, often called wernicke’s encephalopathy or, in advanced stages, Korsikoff syndrome. This condition is considered permanent and irreversible. 

How Doctors Diagnose Alcohol Shakes

Trembling hands can be frustrating and even scary. If you develop a tremor from drinking alcohol, or from withdrawing from alcohol, talk to your doctor, who can assess the following:

  • Symptoms: Are trembling hands your only complaint? Or do you also struggle to walk in a straight line or talk clearly?

    Each form of alcohol tremor we've identified looks a little different, so your doctor can help to identify the underlying cause, if it is treatable, and if it is a sign of a more significant problem.

  • Blood alcohol level: Is alcohol still circulating in your body? Or are you moving through a withdrawal process? The amount of alcohol currently in your body will directly affect how tremors appear.

  • Overall health: A physical exam and certain laboratory tests can be helpful in determining the underlying cause of an alcohol related tremors.

Your doctor may also ask about your drinking habits and recent alcohol consumption. Be honest when asked. Your doctor needs this information to create a clear picture and treatment plan. 

Treating Alcoholic Tremors 

Most people who develop alcohol-related tremors are dealing with withdrawal-related tremors. About half of all alcoholics who abruptly quit drinking will develop signs of withdrawal, which commonly includes tremors.[5] Treating and monitoring your tremors is important, both for your physical comfort as well as to monitor you for progression to more serious forms of withdrawal including seizures, changes to blood pressure, and risk of coma or death.

Your doctor can use certain medications for mild withdrawal, but if your tremors are severe or progressing, your doctor may need to use more dangerous medications like benzodiazepines instead.[5] Within a few days (usually 3-5 days) after going through withdrawal, the tremors should improve.

If your tremors are caused by liver disease or brain damage, your treatment plan is less straightforward. Your doctor may provide you with medications or other therapies to restore smooth movement. But some of these conditions can't be accurately controlled once the damage to your liver or brain has occurred, and can be permanent and irreversible. 

What Should You Do After Recovering from Tremors from Withdrawal?

No matter what caused your tremors, sobriety is critical. If you return to drinking, your shakes can come back or worsen. If you can't stop without help (and many people can't), medication assisted treatment to help prevent alcohol cravings are available.

Three medications are FDA-approved for alcohol use disorder treatment, so your doctor can provide them to ease cravings and lower relapse risks.[6] Therapy and behavioral support are also a critical part of recovery.

With therapy and medications, you can help to prevent progression of tremors and protect your lifelong health! 

Preventing Alcohol Shakes

The best way to ensure that you don't develop alcohol-related shakes is to stop drinking. But if you have years of drinking behind you, it may not be possible to quit cold turkey.

If you're drinking now and want to quit, get help. Medications can help your brain cells to adjust to sobriety. And treatment teams can monitor you while you achieve abstinence and step in if you relapse.

Treatment is the safest way to stay abstinent. Don't attempt to stop drinking suddenly without asking for help. 

Alcohol Shakes & Tremors FAQs 

Why does alcohol cause tremors?

Alcohol-related dehydration/malnutrition, brain damage, withdrawal, and liver damage can all cause tremors. Some alcohol-related tremors are temporary and will fade with time and/or treatment. But other forms can be permanent. And a few forms of alcohol tremors, particularly in the setting of alcohol withdrawal, can be a sign of severe alcohol withdrawal which can be life-threatening. 

How long does shakiness last after drinking?

It depends on the type of alcohol tremor you have. A simple form (like dehydration) will last until you drink enough fluids. A serious form (like brain damage) will be permanent and irreversible. 

Is it normal to shake after drinking too much?

Shakiness is a common symptom of a hangover. The shakiness can be due to how your nervous system responds to the stress of the hangover. Low blood sugar can also contribute to tremors and shakes after drinking a lot and not eating and maintaining good hydration.

If you repeatedly shake after drinking too much, it could be a sign of alcohol withdrawal too. Talk to a doctor or addiction treatment professional to assess whether you need help.

How can I stop alcohol shakes?

If they are due to a short-term issue like dehydration, aim to hydrate and rest. Eating something can also help.

If the shakes are due to alcohol withdrawal, seek out professional help. You may need medication to help you navigate the withdrawal process and keep you safe. Comprehensive addiction treatment is also needed to help you stop drinking for good.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Tremor in Chronic Alcoholism. Neurology. https://pubmed.ncbi.nlm.nih.gov/4058757/. November 1985. Accessed June 2022.
  2. Delirium Tremens. Medscape. https://emedicine.medscape.com/article/166032-overview. August 2021. Accessed June 2022.
  3. Debilitating Tremors in a Patient with Alcohol-Related Cirrhosis. The Lancet. https://www.thelancet.com/journals/langas/article/PIIS2468-1253(21)00302-2/fulltext. November 2021. Accessed June 2022.
  4. Cerebellar Degeneration. National Institutes of Health. https://rarediseases.info.nih.gov/diseases/6019/cerebellar-degeneration. November 2021. Accessed June 2022.
  5. Alcohol Withdrawal Syndrome: Outpatient Management. American Family Physician. https://www.aafp.org/pubs/afp/issues/2021/0900/p253.html. September 2021. Accessed June 2022. 
  6. Medications for Alcohol Use Disorder. American Family Physician. https://www.aafp.org/pubs/afp/issues/2016/0315/p457.html. March 2016. Accessed June 2022.

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