Alcohol Shakes and Tremors in Alcohol Withdrawal

• Alcohol shakes are a symptom of alcohol withdrawal, which happens if you’re dependent on alcohol and stop drinking suddenly.
• Alcohol shakes often affect the hands, but they can affect other parts of the body.
• In some cases, alcohol shakes can indicate delirium tremens (DTs), a potentially life-threatening complication of alcohol withdrawal.
• Tremors may be related to Wernicke-Korsakoff Syndrome (WKS), a memory disorder caused by a lack of vitamin B1.

What Are Alcohol Shakes?

Alcohol shakes, also known as alcohol tremors, can occur after the depressant effects of alcohol wear off. Consuming large quantities of alcohol causes inflammation of the nervous system. Once that wears off, the brain experiences overwhelming activity that may cause excessive stimulation and jitteriness.

Alcohol shakes are also one of the common symptoms of alcohol withdrawal. Shakes or tremors usually affect the hands, but tremors can affect the arms or legs. Alcohol shakes may arise 6 to 8 hours after the last drink and peak in 10 to 30 hours.[2]

In some cases, shakes are an indication of a potentially life-threatening complication called delirium tremens (DTs).[3] The DTs often occur several days after someone with alcohol dependence ends an alcohol binge. The symptoms include hallucinations, delusions, difficulty regulating involuntary bodily functions like heart rate, blood pressure, and body temperature, and changes in mental status.[4]

Tremors can be a warning sign of serious problems. If you experience tremors or shakes when you wake in the morning, while in a hangover, or within a few hours after your last drink, it can indicate an alcohol use disorder.

Tremors with Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff Syndrome (WKS), a severe condition that affects the ability to think, move, see, and remember, can have tremors as a symptom.[5] This condition occurs when there’s a lack of thiamine (vitamin B1), which often occurs in people with alcohol use disorder and malnutrition. Without treatment, WKS can be permanent and may lead to death.

Causes of Alcohol Shakes

Alcohol shakes happen during alcohol withdrawal in people who are physically dependent on alcohol. The amount of alcohol needed to bring on tremors or withdrawal can vary from person to person by several factors, including alcohol use patterns, the length of alcohol use, individual body chemistry, use of other substances, and any existing health issues.[6]

Regular alcohol use changes how the neurotransmitters in the brain work, causing the brain to alter the production of neurotransmitters. When your body is used to alcohol, and you stop drinking suddenly, neurotransmitters like gamma-aminobutyric acid (GABA) and glutamate become imbalanced. This causes withdrawal symptoms like tremors. There may be other symptoms, including hallucinations, increased heart rate, anxiety, insomnia, nausea, restlessness, sweating, vomiting, and seizures.[7]