Alcohol tremors, “the shakes”: causes and treatment
Your hands shake in the morning and steady after the first drink. Most people notice that before they notice anything else.
Most people do not know where the line between heavy drinking and an alcohol use disorder sits. Knowing it tells you when to get help. If you already know you are past that line, what to do about a drinking problem comes down to medical steps taken in order. Government guidelines define moderate alcohol consumption as one daily alcoholic beverage for women, and up to two drinks per day for men. Drinking well past that can turn into an alcohol addiction, which professionals call an alcohol use disorder.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) lists the signs of an alcohol use disorder: cravings, trouble cutting down, and drinking that keeps going even when it causes problems at work or home. Withdrawal symptoms when alcohol leaves the body are another sign, and tremors, or “the shakes,” are among them.
Tremors and alcohol withdrawal
Is shaking a sign of alcohol withdrawal?
It can be. About 21.5 percent of people in alcohol withdrawal have tremors, just over one in five. The DSM-5 lists hand tremors as one of its diagnostic criteria for alcohol withdrawal.
Are tremors a sign of alcoholism?
Not always. Neurological conditions cause tremors too. But if someone drinks heavily and builds a tolerance, stopping suddenly can bring on the shakes.
In that case the tremor is a withdrawal symptom, and withdrawal is one of the signs of an alcohol use disorder. Not everyone in withdrawal shakes. Some get sleep problems or sweating instead, and some get hallucinations.
Why do tremors occur?
Tremors are a withdrawal symptom. Withdrawal starts when a heavy drinker cuts back or stops. Those symptoms come from the imbalances that heavy drinking creates in the body.
Heavy drinking changes the nervous system. Cut the alcohol back or stop it, and the system misfires. It runs overactive, and that is where tremors come from.
How much alcohol do you have to drink to experience tremors?
It varies. Not everyone who drinks goes through withdrawal, but the people who drink most often are the most likely to. Daily drinkers build tolerance, and tolerance is what sets up withdrawal. A daily habit of two to three drinks is enough for some people to get withdrawal tremors, while weekend drinkers rarely shake on the days they do not drink.
How long do tremors last?
It depends on how much a person has been drinking and how severe the withdrawal is. Some heavy drinkers never get tremors at all. Others get at least mild withdrawal. Early signs of withdrawal, such as sweating and a raised heart rate, begin about two days after a person stops drinking. Tremors come after those. In mild cases they stop within a few days.
In more serious cases, withdrawal progresses to late withdrawal, which begins about three days after the last drink. Late withdrawal can worsen into delirium tremens, a condition that can be fatal and that also brings tremors. Withdrawal seizures usually come first. It lasts between three and four days, and sometimes as long as eight days.
In mild cases the tremors fade within a few days. Not everyone gets off that easily. If withdrawal progresses to delirium tremens, the tremors can last a week or more, and emergency medical treatment is needed to prevent serious complications.
Treatment for tremors
Treatment depends on how severe the withdrawal is. Mild withdrawal often resolves in a few days with no treatment at all. Other people need medication.
If you have been drinking heavily and the tremors are not settling on their own, talk to a doctor before you try to treat them yourself. Withdrawal can progress to delirium tremens, which can be life-threatening if untreated.
Medication for alcohol tremors
Benzodiazepines are usually the first choice for treating alcohol withdrawal symptoms like tremors. They are normally used for anxiety, for seizures and for sleep disorders, and they calm the nervous system. Diazepam is a specific type of benzodiazepine that doctors often use for alcohol withdrawal. Sometimes a sedative called a barbiturate is used instead.
Those medications are for moderate to severe withdrawal. With mild symptoms, tremors often stop on their own. Still, if you are planning to quit after heavy drinking, work with a medical professional, even if you expect the shakes to pass. Minor withdrawal may not need a hospital, but a doctor can watch your symptoms and make sure they do not become dangerous.
Some people can get these medications on an outpatient basis, and more serious withdrawal tremor may need hospital care. In an outpatient setting you might take a benzodiazepine prescription and report to a clinic daily so staff can check that you are responding well and improving without complications. As your body adapts to being without alcohol, the doses come down. Severe withdrawal that progresses to seizures or delirium tremens usually means hospital treatment, where doctors give large doses of benzodiazepines by IV so the medication works quickly. As the medication takes hold, the tremors subside along with the other symptoms.
After the shakes stop
Serious withdrawal can need hospital treatment. Minor tremors often stop on their own. Either way, talk to a medical professional before you go through withdrawal, and line up ongoing alcohol treatment after the tremors and other symptoms pass. The shakes are only the first part. Counseling and self-help groups deal with what led to the drinking, and give you something to use when it gets hard. What it takes to get a year sober starts with that work, long after the shakes are gone.
Sources
httpss://www.sciencedirect.com/science/article/pii/S0973688318300562
Related content
Frequently Asked Questions
What causes alcohol tremors?
They come from the nervous system rebounding when alcohol is cut back or stopped. Alcohol suppresses neural activity, and in heavy drinkers the body adapts to that. Take the alcohol away and the system runs hyperactive, which produces the tremor.
When do alcohol tremors start?
Tremors typically appear 6 to 12 hours after the last drink. They are often the first visible sign of withdrawal and usually peak between 24 and 72 hours.
How long do alcohol tremors last?
Most tremors resolve within 5 to 7 days with appropriate medical support. A fine tremor can linger for weeks in some cases. That is usually post-acute, and it improves over time.
Are alcohol tremors dangerous?
Mild tremor on its own is not dangerous. Tremor together with a rapid heart rate, high blood pressure, hallucinations, fever, confusion or seizure activity is a medical emergency. Those signal severe withdrawal or DTs.
How are alcohol tremors treated?
Long-acting benzodiazepines (chlordiazepoxide, lorazepam) reduce tremor by calming the rebound nervous-system activity. Hydration and electrolyte correction go with that, along with thiamine and continuous monitoring.
Can I stop alcohol on my own at home?
For light drinkers, sometimes, under a doctor’s guidance. For heavy daily drinkers, for anyone with prior withdrawal seizures or DTs, and for anyone with cardiac disease, home detox is unsafe. Medical detox greatly reduces the risk of seizures and DTs.
