Managing Alcohol Shakes and Tremors: Why They Happen & What To Do

Managing Alcohol Shakes and Tremors: Why They Happen & What To Do

The clinical term for alcohol shakes is tremors. An involuntary shaking of the hands, legs, or other parts of the body, tremors are caused by a temporary or permanent impairment in the cerebellum and motor cortex. Unless these two brain areas are functioning properly, a person may experience tremors or even seizures they cannot control. Tremors often affect people suffering from neurological disorders, like muscular dystrophy or cerebral palsy.

Are alcohol tremors and shakes a sign of addiction?

Chronic drinkers who abruptly stop drinking typically start experiencing symptoms of alcohol withdrawal within six to eight hours after their last drink. In addition to alcohol shakes, signs of alcohol addiction withdrawal also include profuse sweating, agitation, anxiety, heart palpitations, and nausea that lead to extreme vomiting episodes.

Attempting to overcome alcohol addiction by going “cold turkey” is not only dangerous to your health but almost never works. What helps with alcohol withdrawal and achieving sobriety is entering a residential treatment program that provides medical detox, medications to safely reduce alcohol shakes, and therapy to resolve emotional issues underlying alcohol abuse disorder.

Why do alcoholics shake?

Long-term alcoholics will suffer from alcohol shakes because of brain damage, liver disease (cirrhosis), or a disease called Wernicke-Korsakoff syndrome. Cirrhosis of the liver can make an alcoholic shake uncontrollably if enough scar tissue is preventing the liver from removing ammonia and other toxins from the bloodstream. Wernicke-Korsakoff syndrome is predominantly diagnosed in alcoholics with a severe thiamine deficiency due to malnutrition. Signs of Wernicke-Korsakoff include loss of memory, tremors/alcohol shakes, and inability to walk without assistance.

Alcohol Withdrawal Night Sweats

Alcohol shakes are frequently accompanied by night sweats when an alcoholic is going cold turkey. The reason why heavy drinkers perspire heavily at night (and often during the day as well) involves alcohol stimulating and depressing the nervous system simultaneously. If you fall asleep while intoxicated, your brain is functioning more slowly than usual. But, your organs – heart, kidneys, liver – are rapidly working overtime to rid your body of alcohol. A fast-beating heart accelerates blood flow throughout the body by widening blood vessels. Vasodilation of blood vessels, whether from alcohol withdrawal or binge drinking, will make you feel hot, flushed, nervous, and excessively sweaty.

The Physiology Behind Alcohol-Induced Tremors

Alcohol-induced tremors, commonly referred to as “the shakes,” are rooted in the profound effects that alcohol has on the central nervous system (CNS). When an individual consumes alcohol regularly, the CNS becomes accustomed to its depressant effects. The body, in response, produces more excitatory neurotransmitters to counteract the sedative properties of alcohol and maintain neural equilibrium. However, when alcohol consumption ceases or is reduced, the body still produces an excess of these excitatory neurotransmitters, leading to hyperactivity in the nervous system. This hyperactivity manifests as tremors, shakes, and other withdrawal symptoms.

On a deeper neurological level, alcohol also impacts the brain’s GABA (gamma-aminobutyric acid) receptors, which are responsible for producing calming effects. Regular alcohol consumption can cause these receptors to become less responsive, meaning more alcohol is needed to achieve the same sedative effect. When alcohol is abruptly removed, the lack of its depressant effect combined with the decreased responsiveness of GABA receptors results in heightened CNS activity. This overactivity, combined with the imbalance in neurotransmitters, gives rise to the visible and often distressing tremors associated with alcohol withdrawal.

How to stop alcohol shakes and reduce tremors

A formal diagnosis of alcohol shakes is sometimes referred to as a cerebellar tremor. Related to degeneration of the cerebellum by long-term consumption of alcohol, a cerebellar tremor makes it difficult for a person to complete any type of movement. For example, an alcoholic or recovering alcoholic with cerebellar tremor who tries to push a button or grasp something would be unable to finish the movement because their hand is shaking so badly. 

Stopping alcohol shakes when they are caused by cerebellar tremors will likely require prescription medications that slow down cell-to-cell signaling within the central nervous system.

Benzodiazepines for Alcohol Shakes and Withdrawal

Benzodiazepines like Lorazepam or Valium are sometimes administered intravenously to alcohol detox patients to reduce tremors. Also available in oral form, benzodiazepines are helpful for treating insomnia, nausea, anxiety, and alcohol withdrawal night sweats affecting detox patients.

Other medications prescribed as a treatment for alcohol shakes include:

Adrenergics (Antihypertensives) for Alcohol Withdrawal Night Sweats and Shaking

Also called beta-adrenergic blockers, adrenergics such as propranolol help block symptoms of detoxification, especially excessive sweating, arrhythmia, body tremors, and rapid heartbeat. Propranolol and other beta-blockers work to improve blood circulation and reduce blood pressure by curbing heart rate and dilating blood vessels.

Alpha-2 Adrenergic Agonists

Clonidine is the most commonly prescribed alpha-2 adrenergic agonist for patients undergoing alcohol detox. Clonidine suppresses central nervous system overactivity to minimize the severity of withdrawal symptoms and help patients complete the detoxification process.

Baclofen for Alcohol Shakes

A skeletal muscle relaxant that curbs nervous system hyperactivity, baclofen has been shown to be effective in treating alcohol shakes and other alcohol withdrawal symptoms. Originally developed to treat muscle spasms associated with multiple sclerosis and cerebral palsy, baclofen is an alternative to benzodiazepines because of its non-addictive properties.

OTC remedies for alcohol shakes

Over-the-counter remedies for alcohol shakes after a night of drinking involve drinking electrolyte-infused bottled water to avoid dehydration, eating well-balanced meals, getting plenty of sleep, and taking walks or bicycling to improve overall health. However, these remedies will work only for people who drink occasionally or are prone to low blood sugar after drinking alcohol.

If you are shivering cold after drinking alcohol, it is because alcohol widens blood vessels, which forces blood closer to the skin’s surface. Taking blood away from the core of the body also takes away heat from the body’s core. Within several hours of drinking a couple of drinks, your core body temperature is much lower than normal. Shivering is a way to stimulate the circulatory system so that blood moves away from the surface of your skin and back to the core of your body.

The Connection Between Alcohol, Nutrition, and Shakes

Chronic alcohol consumption has a profound impact on the body’s ability to absorb and utilize essential nutrients. Alcohol interferes with the digestive process, inhibiting the breakdown of nutrients and their absorption in the intestines. Over time, this malabsorption can lead to deficiencies in vital vitamins and minerals, such as thiamine (vitamin B1), folic acid, magnesium, and zinc. Thiamine deficiency, in particular, is of great concern for chronic alcohol consumers. This essential nutrient plays a pivotal role in nerve function. A deficiency can lead to neurological issues, including peripheral neuropathy and Wernicke-Korsakoff syndrome, both of which can manifest as tremors and shakes.

Furthermore, alcohol increases the excretion of certain nutrients through the kidneys, further exacerbating deficiencies. For instance, excessive alcohol consumption can result in the loss of magnesium, a mineral that plays a crucial role in muscle relaxation and nerve function. A reduced magnesium level can contribute to muscle spasms, cramps, and, notably, tremors. The combined effects of nutrient depletion and the direct neurological impact of alcohol create a situation where the body is both nutritionally compromised and neurologically imbalanced, leading to the pronounced shakes and tremors observed in chronic drinkers.

Distinguishing Between Minor Shakes and Delirium Tremens

Minor shakes, or alcohol tremors, are among the most common symptoms experienced during the early stages of alcohol withdrawal. Typically manifesting within a few hours to a couple of days after the last drink, these tremors are characterized by involuntary shaking, usually of the hands, but can also affect other parts of the body. They are often accompanied by other mild withdrawal symptoms like anxiety, nausea, and irritability. While distressing, minor shakes are not immediately life-threatening and can be managed with appropriate care and supervision.

In contrast, delirium tremens (often abbreviated as DTs) represents the most severe form of alcohol withdrawal, occurring in a small percentage of individuals detoxifying from alcohol. Symptoms typically emerge between 48 to 96 hours after the last drink. DTs are marked by pronounced confusion, hallucinations, severe tremors, and autonomic hyperactivity, which can include rapid heartbeat and elevated blood pressure. Crucially, delirium tremens can be life-threatening and often requires immediate medical intervention. The risk of developing DTs is higher in individuals who have experienced previous episodes of alcohol withdrawal, those with a longer history of heavy drinking, and individuals who consume high amounts of alcohol regularly. Recognizing the distinction between minor shakes and the more severe delirium tremens is crucial in ensuring timely and appropriate care for individuals undergoing alcohol withdrawal.

What you can do to stop alcohol shakes and improve your life

Over-the-counter remedies for alcohol shakes may work for binge drinkers or those who have been drinking heavily for a short period. However, long-term alcoholics should always get help today by contacting EHN Canada. Alcohol withdrawal requires professional help if you or someone you know cannot abstain from alcohol because of severe withdrawal symptoms.

What helps with alcohol withdrawal?

Several prescription medications are available that provide relief from withdrawal symptoms such as cravings for alcohol and alcohol shakes.

Disulfiram (Antabuse)

By inhibiting the ability of the liver to metabolize alcohol, Antabuse increases acetaldehyde levels in the body that worsens toxic reactions (cramping, sweating, nausea, and fatigue) when a detoxing alcoholic takes a drink. This cancels the feeling of intoxication produced by alcohol and heightens its negative effects to help prevent relapse.

Opioid Antagonists (Naltrexone)

An opioid antagonist that is quickly absorbed by the body, Naltrexone has been shown in clinical trials to reduce the severity and frequency of relapse associated with alcohol and opioid addictions. In addition, a COMBINE study revealed that Naltrexone is effective when used in primary care settings without adjunct counseling.


Valium, Ativan, and Librium are the primary benzodiazepines used to treat alcohol withdrawal symptoms. They work well to reduce anxiety, insomnia, hallucinations, and alcohol shakes during and after medical detoxification. As symptoms diminish over time, the person taking benzodiazepines will be slowly weaned from taking these medications.

When do I need professional help for alcohol shakes and tremors?

If you try to stop drinking by going cold turkey, and experience alcohol withdrawal symptoms so severe that you start drinking again, then you do need professional help–now.

You may also be at risk of having severe alcohol withdrawal symptoms such as seizures or delirium tremens (DTs). Factors exacerbating this risk of life-threatening conditions include:

  • Previous history of relapse and/or DTs
  • Longer duration of alcohol abuse disorder (typically more than two years)
  • Onset of reduced liver functioning and/or liver disease
  • Overwhelming cravings for alcohol
  • Being over 35 years old
  • Having a chronic disease (diabetes, hypertension, obesity)
  • Mixing drugs and alcohol

Long-term alcoholics may have symptoms of delirium tremens as soon as 48 hours after their last drink. However, DTS can also affect an alcoholic up to 10 days after that last drink due to the severity of brain damage. Common signs of DTs are similar to symptoms of an acute psychotic episode and involve:

  • Disorientation
  • Agitation
  • Paranoia
  • Panic
  • Visual hallucinations
  • Auditory hallucinations
  • Extreme sensitivity to light or sounds
  • Coma-like unconsciousness

What starts out as alcohol shakes in people suffering DTs could develop into full-blown seizures. The most common type of seizure affecting alcoholics who detox without medical supervision is called a generalized tonic-clonic seizure.

Heart rhythm disturbances during a cold turkey detox can cause heart arrhythmias serious enough to interfere with normal heart contractions. Although this type of alcoholic heart failure is seen more in older or chronic alcoholics, it could happen to alcoholics at any age.

Is alcohol nerve damage permanent?

Alcoholic neuropathy (alcohol nerve damage) is usually permanent. About half of all long-term alcoholics will deal with alcoholic neuropathy for the rest of their lives. Symptoms of alcohol nerve damage typically emerge following medical detoxification and include:

  • Painful numbness and tingling in the arms, legs, hands, and feet
  • Muscle weakness, spasms, and chronic alcohol shakes
  • Difficulty urinating and/or incontinence
  • Periodic episodes of nausea and vomiting
  • Problems speaking clearly (inability to form words and/or complete sentences)
  • Unsteadiness, especially when walking

Although alcohol nerve damage is not life-threatening, it will reduce a person’s quality of life and require ongoing supportive treatment.

What can recovering alcoholics do to reduce tremors?

Alcohol tremors may sometimes occur after a period of abstinence. Recovering alcoholics who have been sober for one year can find themselves experiencing alcohol shakes at random times during the day. Long-term alcoholics who are in recovery could develop a permanent postural tremor that is characterized by the inability to maintain a specific position, such as standing on foot or holding an arm extended for several seconds. In addition to adopting healthy lifestyle choices, people with alcohol tremors often take propranolol to control tremors.

Do you need medical treatment for alcohol shakes?

Before contacting your physician about alcohol tremors, we recommend gaining insight into the possibility you may need more than prescription medications for alcohol shakes.

Post-Recovery: Coping Strategies for Residual Shakes and Tremors

Even after the acute phase of alcohol withdrawal has passed and recovery has begun, some individuals may continue to experience residual shakes and tremors. These lingering effects can be a stark reminder of past struggles, but they can also be managed with the right strategies. One effective approach is engaging in regular physical activity. Simple exercises, especially those that focus on fine motor skills and coordination like yoga or tai chi, can help in strengthening muscles and improving control over tremors. Deep-breathing exercises and meditation can also be beneficial, as they promote relaxation and help in reducing anxiety, which can often exacerbate tremors.

Moreover, it’s essential for individuals in recovery to maintain a balanced diet, ensuring that they’re replenishing any vitamins or minerals that might have been depleted during periods of heavy drinking. Nutritional supplements, particularly those rich in B vitamins and magnesium, might be beneficial. However, it’s always advisable to consult with a healthcare provider before starting any supplementation. Lastly, joining a support group or seeking counseling can provide emotional backing and practical advice from others who have faced similar challenges. Sharing experiences and coping techniques in a supportive environment can empower individuals in their post-recovery journey, ensuring they’re not alone in navigating the challenges of residual shakes and tremors.

Call EHN Canada today for more information about getting sober and staying sober

EHN Canada’s recovery centres located throughout Canada provide evidence-based, compassionate treatment for alcoholism, drug addiction, and mental health issues. Whether you need outpatient therapy for an alcohol abuse disorder, medical detox, or residential treatment for chronic alcoholism, please call us today to receive immediate assistance.

EHN Canada has locations across Canada that specialize in addiction and mental health treatment. If and when you’re ready, please reach out at 1-416-644-6345 to begin your recovery journey. 

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