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Alcohol Shakes or Tremors

Learn why alcohol shakes, known as tremors, refer to a withdrawal symptom that manifests in various areas of the body, particularly in the hands.

What Are Alcohol Shakes Causes & Effects?

When a person struggling with chronic or long-term alcohol abuse quits drinking, they may experience tremors, also known as alcohol shakes.1,2 Tremors are involuntary shaking in one or multiple areas of the body and can occur intermittently or be constant.1,2 Two of the many possible causes of tremors are acute alcohol withdrawal and excessive alcohol use.2 

Tremors are caused by a problem in the areas of the brain that control the body’s muscles. Although not life-threatening, they can be embarrassing and even disabling, making it difficult to perform everyday functions.1 If a person thinks they may be going through alcohol withdrawal, they should seek medical care in order to safely detox. 

Because alcohol withdrawal can potentially be life-threatening, anyone going through withdrawal should be monitored by a medical professional, who can make it a more comfortable and safer process. The type of detox program or level of intensity needed will depend on the severity of alcohol dependence and other factors.6 Detox alone is seldom enough to help those with a substance use disorder maintain abstinence long-term. Rather, detox should be followed by effective substance use disorder treatment.8

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Diagnosis and Symptoms of Tremors

Symptoms for diagnosing types of shakes or tremors include:

  • Depending on how severe the withdrawal syndrome is, alcohol withdrawal symptoms may begin about 6 hours after the last drink (or decrease in drinking) or may begin sooner.4 Withdrawal symptoms typically peak by 24 to 72 hours and can last for a few weeks.6
  • There are more than 20 types of tremors, most classified by their appearance and source. Tremors that may be due to excessive alcohol use or withdrawal include cerebellar tremor and enhanced physiologic tremor.2
  • The symptoms of tremors include a rhythmic shaking in the body, typically the hands; trouble writing or drawing; a shaky voice; or problems holding and controlling utensils. 1,2
  • Tremors can also be a symptom of a more severe type of alcohol withdrawal, delirium tremens (DTs), but DTs is thought to only occur in less than 5% of individuals in alcohol withdrawal.3,6
  • Tremors are diagnosed based on an individual’s medical history as well as a physical and neurological examination.2

Symptoms of Tremors

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Will I Experience Symptoms of Withdrawal?

It is impossible to know, for certain, in advance if any person will experience symptoms of withdrawal when they choose to discontinue alcohol use. Depending on an individual’s level of physical dependence, withdrawal symptoms may be anywhere from mild to severe and often occur between 6 hours and 48 hours after the last time alcohol is consumed or after drinking is decreased.5

Symptoms often reach their worst by 24 hours to 72 hours.6 Some individuals may develop alcohol withdrawal seizures, which typically start between 6 and 48 hours after stopping/reducing drinking.4 Delirium tremens, when it occurs, usually begins between 48 and 72 hours and can cause death.4,7 DTs are a neurologic syndrome marked by changes in mental status and autonomic nervous system excitation.4,7

DTs is thought to manifest in less than 5% of the individuals in alcohol withdrawal.3 A history of seizures, past episode(s) of DTs, comorbidities, past detoxification, and a long period of time before their last drink may increase the risk of DTs.7 Delirium tremens symptoms may include fever, body tremors, severe confusion, agitation, hallucinations, rapid heartbeat, high blood pressure, anxiety, and sweating.4,7

If you suspect you or someone else may be experiencing withdrawal, seek medical attention immediately.

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[1]. MedlinePlus. (2018). Tremors.

[2]. National Institute of Neurological Disorders. (2018). Tremor Fact Sheet.

[3]. National Clinical Guideline Centre (UK). (2010). Acute Alcohol Withdrawal. Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications. NICE Clinical Guidelines, No. 100, 2(2.1).

[4]. Kattimani, S. and Bharadwaj, B. (2013). Clinical Management of Alcohol Withdrawal: A Systematic Review. Ind Psychiatry; Jul-Dec 22 (2); 100-108.

[5]. Hugh Myrick, M.D., and Raymond F. Anton, M.D. (1998). Treatment of Alcohol Withdrawal. Alcohol Health & Research World 22(1): 38-43.

[6]. MedlinePlus (2016). Alcohol Withdrawal.

[7]. Rahman A, Paul M. (2018). Delirium Tremens (DT). U.S. National Library of Medicine.

[8] National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).