Medically Reviewed

Alcohol Shakes & Tremors: When Do I Need Professional Help?

Tremors or shakes are a common sign of alcohol withdrawal but are also warning signs of more serious issues and complications associated with alcohol misuse. It is important to be aware of the dangers of alcohol tremors so you can understand when you should seek medical help for alcohol-related shakes. Early treatment for alcohol dependence or alcohol misuse can be essential in preventing alcohol withdrawal and the potential dangers and consequences that comes from alcohol misuse.

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What are Alcohol Shakes?

Alcohol shakes, which are also called tremors or jitters, are one of the tell-tale symptoms of alcohol withdrawal.1 Shakes or tremors commonly affect the hands, but can also be seen in other areas, such as the arms or legs.1,2 Tremors can also be an indicator of a withdrawal complication known as delirium tremens (DTs), which can present 2-3 days after someone who is dependent on alcohol ends a long and intense drinking binge. DTs can be life-threatening and involves changes in mental status, hallucinations, delusions, and trouble regulating involuntary body functions such as blood pressure, heart rate and body temperature.3,4 Alcohol shakes commonly arise 6-8 hours after drinking is stopped, and peaks in 10-30 hours after your last drink.1,5 

However, tremors can also be a warning sign of a bigger issue. If you experience tremors or shakiness upon waking up in the morning, during a hangover, or after a few hours of not drinking, this can be a warning sign of an alcohol use disorder.5 Tremors can also be one of the symptoms of a more severe condition known as Wernicke-Korsakoff Syndrome (WKS), which requires immediate treatment to prevent it from becoming permanent and leading to death.3,4 Thiamine (vitamin B1) deficiency plays a role in the development of tremors and other symptoms associated with WKS.3 WKS affects the ability to think, move, see, and remember, and can be reversed in early stages.3,4

Causes of Alcohol Shakes

Alcohol shakes are a result of withdrawal in people who are physically dependent on alcohol.2,6 The amount of alcohol needed to cause tremors or withdrawal is different for each person, depending on how long you have been drinking for, how much you drink regularly, your body chemistry, whether you use other substances, and if you have any other health issues.1

Regular alcohol use changes how the neurotransmitters (brain chemicals) work in your brain, causing your brain to alter the production of neurotransmitters.7 When you stop drinking, neurotransmitters such as Gamma-Amino-Butyric Acid (GABA) and glutamate are imbalanced, leading to withdrawal symptoms such as tremors.7 This can also lead to other withdrawal symptoms and more severe consequences, including:7,8

  • Anxiety.
  • Depression.
  • Hallucinations.
  • Increased heart rate.
  • Insomnia.
  • Nausea.
  • Restlessness.
  • Sweating.
  • Vomiting.
  • Seizures.
  • DTs.

In the below video, our medical director, Dr. Calarco, explains how alcohol can cause shakes and tremors.

@americanaddictioncenters How can alcohol cause shakes and tremors? #alcoholdetox #alcoholwithdrawal #withdrawalsymptoms #addictionrecovery #realtalkrecovery ♬ Pieces – Danilo Stankovic

Treatment for Alcohol Shakes

Since alcohol shakes can be a sign of Wernicke-Korsakoff Syndrome WKS, which can be extremely dangerous, it is important to see a doctor immediately if you are exhibiting signs of tremors. They can help you decide on a treatment that is likely to be most effective for your needs. There are a range of treatment methods to treat shakes. The first step in treatment is most likely to begin with you detoxing from alcohol in a professional treatment center since stopping cold turkey can elicit dangerous withdrawal symptoms and complications 5 Some treatment options that may be used in a professional detox setting include:

  • Benzodiazepines, such as Librium or Valium to manage withdrawal symptoms, including tremors, and lower the risk of developing DTs.5,6
  • Thiamine, to lower the risk of developing WKS and reduce tremors.3,9
  • Propranolol, a beta-blocker, can reduce tremors.6,10

Self-Assessment for Alcohol Use Disorder

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  1. S. National Library of Medicine. (2021, November 23). Alcohol withdrawal.
  2. S. National Library of Medicine. (2021, October 27). Tremor.
  3. Myrick, H., & Anton, R.F. (1998). Treatment of alcohol withdrawal. Alcohol health and research world, 22(1), 38-43.
  4. Trevisan, L.A., Boutros, N., Petrakis, I.L., & Krystal, J.H. (1998). Complications of alcohol withdrawal: Pathophysiological insights. Alcohol health and research world, 23(1), 61-66.
  5. National Clinical Guideline Centre (UK). Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet]. London: Royal College of Physicians (UK); 2010. (NICE Clinical Guidelines, No. 100.) 2, Acute Alcohol Withdrawal.
  6. National Institute of Neurological Disorders and Stroke. (2021, November 15). Tremor fact sheet.
  7. Newman, R.K., Stobart Gallagher, M.A., & Gomez, A.E. (2021). Alcohol withdrawal. Treasure Island, FL: StatPearls.
  8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  9. S. National Library of Medicine. (2021, November 23). Wernicke-Korsakoff syndrome.
  10. Koller, W., O’Hara, R., Dorus, W., & Bauer, J. (1985). Tremor in chronic alcoholism. Neurology, 35(11), 1660-1662.

Last Updated on Sep 15, 2022
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