In moderation, alcohol can be part of a healthy lifestyle. Government guidelines define moderate alcohol consumption as one daily alcoholic beverage for women, and up to two drinks per day for men. Excessive alcohol use, on the other hand, can become problematic and lead to an alcohol addiction, which professionals call an alcohol use disorder.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5) describes the signs of an alcohol use disorder. These include symptoms such as cravings for alcohol, difficulty cutting down on drinking, and continuing to drink, even when it causes problems with work or family. Another sign of an alcohol use disorder is experiencing symptoms of withdrawal when alcohol begins to leave the body. One such withdrawal symptom is tremors, or “the shakes.”
Tremors and Alcohol Withdrawal
Is shaking a sign of alcohol withdrawal?
The most simple answer is that it can be. In fact, a 2018 study in the professional journal Alcoholism found that among people experiencing alcohol withdrawal, 21.5 percent, or just over one-fifth, had tremors. In addition, the DSM-5 lists hand tremors, or “the shakes” as one of the diagnostic criteria for alcohol withdrawal.
Are tremors a sign of alcoholism?
Given the fact that alcohol withdrawal can cause tremors, you may be wondering if tremor is a sign of alcoholism. While tremors can suggest that someone is withdrawing from alcohol, alcoholism is not the only cause of shaking. Some people may have tremors from underlying neurological conditions, but if a person consumes alcohol excessively and develops a tolerance, he or she may experience tremors when alcohol use is stopped suddenly.
In this case, tremor can be a sign of alcoholism, as it indicates that a person is undergoing withdrawal, which is one of the symptoms of an alcohol use disorder. That being said, not everyone who undergoes alcohol withdrawal will get the shakes, as there are other withdrawal symptoms, including sleep difficulties, sweating, and hallucinations.
Why do Tremors Occur?
As mentioned, tremors are a sign of alcohol withdrawal, which occurs when a person who consumes large quantities of alcohol reduces or stops his or her drinking. According to a 2018 report in the Journal of Clinical and Experimental Hepatology, withdrawal symptoms are a result of physiological imbalances that happen when a person abuses alcohol.
Excessive alcohol consumption affects the nervous system, so when a person reduces drinking or stops it altogether, the nervous system experiences dysfunction. It becomes overactive, ultimately leading to withdrawal symptoms like tremors.
How much alcohol do you have to drink to experience tremors?
In terms of the amount of alcohol a person has to drink to experience tremors, this may vary from person-to-person. According to medical doctors, not everyone who drinks will experience withdrawal, but those who drink most frequently are more likely to experience withdrawal symptoms, including tremors. For example, daily drinkers are at risk of developing tolerance and therefore withdrawal. Some people may even experience withdrawal-related tremors with a daily habit of two to three drinks, whereas those who drink only on the weekends are less likely to have tremor on days they do not drink.
How Long do Tremors Last?
The duration of alcohol-related tremors depends upon the extent of one’s alcohol use, as well as the severity of the withdrawal. Some people who abuse alcohol will never experience withdrawal symptoms like tremors, whereas others will experience at least mild withdrawal. According to a doctor writing for The Hospitalist, early signs of withdrawal, such as sweating and elevated heart rate, begin about two days after a person stops drinking, and tremors begin after these symptoms. In mild cases, tremors will stop within a few days.
In more serious cases of withdrawal, symptoms may progress to what is called late withdrawal, which begins about three days after a person has his or her last alcoholic beverage. Late withdrawal can worsen until a person develops a potentially fatal condition called delirium tremens, which can also be accompanied by tremors or “the shakes.” This condition is typically preceded by withdrawal seizures, and it lasts between three and four days, but can have a duration as long as eight days.
Given the range of severity of alcohol withdrawal symptoms, a person who experiences tremors can expect them to dissipate within a few days in mild cases, but not everyone will be this lucky. If withdrawal progresses to delirium tremens, the tremors can last for a week or more, and emergency medical treatment is necessary to prevent serious complications.
Treatment for Tremors
Just as the duration of tremors can vary, the ideal treatment can differ based upon withdrawal severity. Some people may experience only mild alcohol withdrawal and find that tremors stop in a few days with no treatment. Others may require medication to treat withdrawal symptoms like tremors.
If you have a history of heavy drinking and tremors are not stopping on their own, you may be wondering what to take for alcohol shakes. In this case, it is best to consult with a doctor, especially given the fact that withdrawal can progress to delirium tremens, which can be life-threatening if untreated.
Alcohol Tremors Medications
According to The Hospitalist, a class of drugs called benzodiazepines is usually the first choice for treating alcohol withdrawal symptoms like tremors. These drugs are typically used to treat anxiety, seizures, and sleep disorders, and they have a calming effect on the nervous system. Diazepam is a specific type of benzodiazepine that doctors often use to treat alcohol withdrawal. Sometimes, doctors will use a sedative medication called a barbiturate to treat tremors.
The above medications are typically used in cases of moderate to severe withdrawal, so if you are experiencing only mild withdrawal symptoms, tremors may simply stop without any medication. If you do plan to quit drinking after a period of heavy or extensive alcohol use, it is always best to work with a medical professional, even if you think the shakes will go away on their own. You may not require treatment in the hospital for minor withdrawal, but a doctor can monitor your symptoms to ensure they do not become dangerous.
In some cases, you may be able to receive medications on an outpatient basis, but more serious cases of withdrawal tremor may require hospitalization. If you can be treated in an outpatient setting, you may be taking a benzodiazepine prescription and report to a clinic daily so that medical staff can ensure you are responding well to medications and continuing to improve with no serious complications. Over time, as your body adapts to being without alcohol, medication doses will be reduced. On the other hand, if you have severe withdrawal that progresses to seizures or delirium tremens, hospital treatment will likely be warranted. In this case, doctors will likely give large doses of benzodiazepines via IV, so that the medication can work quickly to relieve symptoms and treat the condition. As these medications work to relieve the body of alcohol withdrawal, you can expect tremors and other symptoms to subside.
Hospital treatment may be necessary for tremors that occur with serious cases of alcohol withdrawal, whereas tremors may stop on their own in minor cases, but it is always best to seek the advice of a medical professional if you plan to undergo alcohol withdrawal. Regardless of whether medical care is needed to stop the shakes, it is important to also follow-up for ongoing alcohol treatment after tremors and other withdrawal symptoms pass. Getting through the shakes is only the first part of achieving lasting sobriety from alcohol; psychological treatment, such as counseling and self-help groups can help to address the underlying issues that led to alcohol addiction and provide you with tools and coping skills for staying abstinent.
NIH, “Drinking Levels Defined”, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
NIH, “Alcohol Use Disorder”, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
Sandeep Grover / Abhishek Ghosh, “Delirium Tremens: Assessment and Management”, 2018, https://www.sciencedirect.com/science/article/pii/S0973688318300562
Michael Weaver, MD, “Dealing with the DTs”, 2007, https://www.the-hospitalist.org/hospitalist/article/123281/dealing-dts
Johnna Medina, Ph.D., “DSM-5 Alcohol Withdrawal Symptoms”, 2020, https://psychcentral.com/disorders/alcohol-withdrawal/