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Alcohol shakes refer to uncontrolled shaking, typically in the hands but also in other parts of the body. They can be sporadic or they can happen continuously.

Shakes and tremors typically affect middle-aged and older people, although they can happen to people of any age. Though tremors themselves are rarely dangerous, they can make it hard to perform daily tasks.

Is shaking a sign of alcoholism?

Shakes or tremors in the hands can be a sign of alcohol dependency.

However, there are several other causes of shaking, so it’s important to speak to a doctor in order to get a correct diagnosis.

Other (non-alcohol-related) causes of shaking include:

  • Anxiety
  • Brain injury
  • Caffeine overdose
  • Cerebellar disease
  • Huntington’s disease
  • Parkinson’s disease
  • Low blood sugar
  • Medication side effects
  • Multiple sclerosis
  • Overactive thyroid
  • Seizure
  • Stroke

Shaking is most likely to be related to alcoholism if you are a heavy drinker who has recently stopped drinking.

However, as we will see, sometimes heavy drinkers start shaking without having stopped drinking.

If you are a heavy drinker whose hands are shaking, and you had your last drink recently, this could be a sign of liver disease or alcohol-related brain disease.

What are the symptoms of tremors?

Tremors are normally pretty easy to spot. The symptoms include:

  • Trembling in the hands, arms, legs or torso
  • Quavering voice
  • Inability to write or draw
  • Difficulty holding things, such as cutlery or pens.

How are tremors diagnosed?

It is important to diagnose shakes and tremors accurately.

If shakes or tremors are due to alcohol withdrawal, then we would expect them to occur around 6 hours after the final drink. This is when withdrawal symptoms typically begin. Withdrawal symptoms are strongest in the first 24-72 hours, but can continue for up to 2 weeks. In some extreme cases, they can last even longer: this is known as post-acute withdrawal syndrome or ‘PAWS’.

There are around several different kinds of tremors, which are distinguished by factors such as appearance and include dystonic tremors, psychogenic tremors and more.

When diagnosing tremors, doctors will take into account a person’s medical history and their history with substances. Since tremors can be a symptom of so many different conditions, doctors will need all the facts in order to give an accurate diagnosis.

Tremors can be a symptom of delirium tremens, a serious condition associated with alcohol withdrawal. Delirium tremens can also cause hallucinations and occurs in very dependent drinkers.

Why do I shake after I have had a drink?

If you find that you start shaking after a drink, there is a simple explanation.

Alcohol is a depressant. When you drink, your brain gets accustomed to a low level of stimulus. However, as soon as you stop drinking, the depressant effect wears off. Your brain is now exposed to a lot more stimulation as the nervous system goes into overdrive, causing tremors.

Those who only drink alcohol occasionally are very unlikely to get tremors. Tremors only occur in those whose bodies are accustomed to large amounts of alcohol on a daily basis. Tremors are a warning sign that you may be dependent on alcohol.

If you think you may be dependent on alcohol, you should strongly consider getting treatment.

How do I know if I am dependent on alcohol?

Besides tremors, there are lots of other signs to watch out for if you think you may be dependent on alcohol.

The DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, 5th edition) lists eleven symptoms of alcohol use disorder. We’ve paraphrased them below.

They are:

  1. Drinking alcohol in excess on a regular basis.
  2. Trying and failing to reduce or control alcohol use.
  3. Spending a lot of time obtaining alcohol, drinking alcohol or recovering from the effects of alcohol.
  4. Experiencing strong cravings for alcohol.
  5. Failing to uphold obligations at home, school, or work.
  6. Persistent alcohol use despite clear negative consequences.
  7. No longer engaging in things that one previously enjoyed because of alcohol.
  8. Drinking alcohol even when it is harmful or dangerous.
  9. Drinking alcohol despite medical or mental health problems which are made worse by alcohol.
  10. Building up a high tolerance to alcohol.
  11. Going through withdrawal symptoms when alcohol is unavailable.

If you experience 2 to 3 of these symptoms, that qualifies as a mild AUD.

4 to 5 represents a moderate AUD.

6 or more suggests you may have a severe AUD.

Besides shaking, what other withdrawal symptoms are there?

Alcohol shakes are one sign of withdrawal. There are many more. If you think you may be going into withdrawal, watch out for these signs and symptoms.

  • Anxiety
  • Confusion
  • Delusions and hallucinations
  • Depression
  • Insomnia
  • Irritability
  • Nausea
  • Seizures
  • Sweating

The symptoms you incur when you stop drinking alcohol will depend on how much alcohol you were drinking, and for how long. Someone with more severe alcohol dependency is likely to have more severe withdrawal symptoms.

What is delirium tremens? Are tremors a symptom of delirium tremens?

Delirium tremens is a very serious kind of confusion caused by alcohol withdrawal. It tends to occur around three days into withdrawal, and can last for between 48 and 72 hours.

Symptoms of delirium tremens include shaking/tremors, shivering, sweating and a fluctuating heartbeat. They can also include hallucinations.

You are more likely to get delirium tremens if you have been physically dependent on alcohol for some time, and you stop drinking suddenly.

How do I know if my shaking is caused by delirium tremens?

Shaking can be a normal withdrawal symptom, as well as a symptom of delirium tremens.

There are a few ways to tell the difference.

  1. If your tremors are a normal withdrawal symptom, they are likely to kick in around 6 hours after your last drink. If they are a symptom of delirium tremens, on the other hand, they will probably begin around 3 days after your last drink.
  2. If you are experiencing hallucinations, then your tremors are more likely to be a consequence of delirium tremens. If your withdrawal symptoms are relatively mild, then they are more likely to be a normal withdrawal symptom.

What else could be causing my tremors?

If you think that your tremors may be alcohol-related, but not caused by withdrawal, there are a couple of other conditions you should be aware of. They are liver disease and alcohol-related brain damage.

In advanced stages, liver disease is known to cause hand-shaking, or asterixis. Also known as ‘liver flap’, this hand movement has been compared to a bird flapping its wings. It is caused by hepatic encephalopathy (HE), a condition in the brain which occurs in the later stages of liver disease.

Alcohol-related brain damage can lead to ‘intention tremors’. Intention tremors are most obvious when someone tries to make a deliberate movement, but can also be visible when someone is at rest. Someone with alcohol-related brain damage may also exhibit poor coordination, unsteadiness and flickering eye movements, sometimes referred to as nystagmus.

Further reading

https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm

This outlines the criteria for an alcohol use disorder according to the DSM-5. It goes into a bit more detail than our article.

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet#4

This is a helpful fact sheet which discusses the causes and diagnosis of tremors. It goes into more detail on different kinds of tremors and the terminology used to classify them.

boris

Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline.