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Alcohol withdrawal side effects can range from moderate to severe. Among the more common side effects are tremors or “the shakes.” These alcohol withdrawal tremors are part of the body’s response to a sudden decrease or cessation of alcohol consumption after long term, heavy use.
The sudden absence of alcohol sends the body into overdrive as it tries to compensate and stabilize the chemical imbalance caused by alcohol misuse. This process of the body stabilizing itself is called alcohol withdrawal and it often includes tremors.
Use this resource to learn more about why alcohol tremors occur, what to expect and what to do if you or a loved one experiences alcohol tremors.
Alcohol Shakes Key Facts
- Alcohol tremors are involuntary shakes caused by nervous system overactivity
- Alcohol withdrawal shakes typically begin six to 24 hours after the last drink and can last three to five days.
- If tremors progress to delirium tremens or other severe side effects, it is crucial to seek medical support.
- Clinicians can assess the severity of alcohol withdrawal and provide appropriate treatment for tremors, including medications.
- Detox programs and follow up recovery treatment are available to address both physical and psychological aspects of alcohol use disorder.
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What Are Alcohol Withdrawal Shakes? (a.k.a. Alcohol Tremors)
Alcohol tremors are a common part of alcohol withdrawal syndrome (AWS). These tremors are an involuntary response that happen as the body adjusts to the absence of alcohol and are also called shakes.
This withdrawal side effect is the reason many people have shaky hands after drinking stops. The tremors are an indication that your body has become physiologically dependent on alcohol, and the withdrawal process has started.
Alcohol Shakes vs. Hangover
How can you tell the difference between alcohol shakes and a hangover?
Timeline
- A hangover is the most intense when it begins and then improves throughout the day.
- Withdrawal tremors don’t start until six to 24 hours after the last drink and then increase in intensity.
Severity
- Hangovers typically don’t require medical attention.
- Signs of severe withdrawal symptoms, such as confusion, fever, seizures or hallucinations, should be considered a medical emergency and require immediate support.
Why Do Alcohol Shakes Happen?
Chronic alcohol use causes the body to become dependent on alcohol. Here’s what happens.
- The frequent presence of alcohol alters the brain’s release of GABA (gamma aminobutyric acid), a neurotransmitter that slows the neurological system.
- Alcohol also suppresses the production of glutamate, an excitatory neurotransmitter.
- Over time, the brain adapts to the presence of alcohol, so it no longer produces the normal amounts of these neurotransmitters.
- When alcohol suddenly is not present, the neurotransmitters “rebound” to try to stabilize the body.
- The rebound creates an overexcited central nervous system, which results in anxiety, high heart rate and tremors.
Who is at risk?
Anyone who undergoes alcohol withdrawal may experience alcohol tremors.
You are more likely to experience alcohol shakes if you have one or more of these risk factors:
- If you are a senior
- A medical illness
- Experienced prior severe withdrawal
- Heavy daily alcohol use
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How Long Do Alcohol Tremors Last?
While alcohol tremors are a common side effect of alcohol withdrawal, it’s important to know how long they should last and what to expect.
Alcohol Tremors Timeline
- Onset: 6-24 hours after last drink
- Peak: 24-72 hours
- Recovery: 3-5 days
During this time, it is common to experience sleep disturbances and anxiety. The combination of these symptoms can linger more than a week in some people.
This timeline can vary based on concurrent sedative use, any comorbidities present and your prior drinking patterns.
When to Seek Medical Support
It is possible for withdrawal symptoms to require medical attention. During the first six to 48 hours, the risk of seizures is highest.
Delirium tremens are also a risk, typically during days two through eight after your last drink. These conditions indicate a life threatening level of neurological hyperactivity and require immediate medical support.
When to Call 911
If any of the following red flags appear, or if the person cannot be safely monitored, call 911:
- Repeated vomiting
- High fever
- Seizure
- Confusion/hallucinations
- Fainting
- Chest pain
- Very high blood pressure or heart rate
When to Get Same Day Medical Care
Safe alcohol withdrawal often requires medical care. To ensure symptoms don’t progress to lethal levels, seek same day medical care for the following symptoms:
- Moderate tremor
- Anxiety
- Inability to sleep
- Heart rate above 100
Never “treat” alcohol withdrawal symptoms by drinking. This can worsen symptoms and increase the risk of seizure. Instead, prior to receiving medical care, take the following steps to stay safe:
- Avoid driving
- Drink water and nonalcoholic fluid to remain hydrated
- Arrange for constant supervision to monitor progress
Clinical Assessment & Treatment of Alcohol Withdrawal Shakes
Clinicians can assess the severity of withdrawal to determine appropriate treatment for alcohol shakes.
They use the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) to measure severity. This helps determine what, if any, medications should be prescribed.
CIWA-Ar
The assessment includes a rating scale for 10 withdrawal symptoms:
- Nausea
- Tremor
- Anxiety
- Agitation
- Sweats
- Orientation
- Headache
- Visual disturbance
- Tactile disturbance
- Auditory disturbance
The total score guides clinicians in treatment options.
- 0-9: Mild
- 10-18: Moderate
- 19+: Severe
Scores in the moderate range may indicate a need for medications to assist with withdrawal. Severe withdrawal is usually treated with medications.
Clinicians repeat the assessment to determine the trend of symptoms. They combine these scores with current vital signs and your medical history to guide treatment.
Withdrawal Medications
Several medication and supplement options are used for effective treatment of alcohol withdrawal and alcohol tremors.
Benzodiazepines: (diazepam/lorazepam) These are considered the first line treatment for alcohol withdrawal. They are prescribed using fixed dosing or symptom triggered dosing, to stimulate GABA receptors.
Adjunct medications may be used based on symptoms and medical history. These include:
- Carbamazepine/gabapentin to calm the central nervous system
- Phenobarbital to target GABA and glutamate receptors
- Beta-blockers/clonidine to treat autonomic symptoms
- Thiamine to address thiamine deficiency
Additional support may be provided through antiemetics (nausea medication), hydration and electrolytes.
Choosing the Right Detox Setting
Detox programs are available in inpatient and outpatient settings. It’s important to undergo detox at the appropriate level of care. This chart indicates which setting may be best for your situation.
| Outpatient Detox | Inpatient/Medication Assisted Detox |
| ● Mild symptoms ● Reliable support at home ● Phone/check in access ● No severe comorbidity All boxes should be checked to receive outpatient detox. | ● History of DTs/seizures ● Severe CIWA-Ar score ● Pregnancy ● Older age ● Significant medical or psychiatric illness ● Polysubstance use ● Unstable housing ● Lack of transportation ● Remote location ● Prior complicated withdrawal if any of these boxes are checked, inpatient care is recommended. |
After the Shakes: Staying Alcohol Free
Once withdrawal is complete and alcohol shakes stop, ongoing treatment is vital to maintain sobriety. Support is available in the form of medication, evidence based therapies, and other aftercare options.
Alcohol Use Disorder (AUD) Medications
Clinicians may recommend starting or continuing medications following acute withdrawal stabilization. They will prescribe and dose based on your goals and other medical considerations.
Three medications have been approved by the FDA to treat AUD:
- Acamprosate
- Disulfiram
- Naltrexone
Call A Treatment Provider
For a conversation about what treatment options are available to you.
Make a Call
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Evidence Based Behavioral Therapy
Behavioral therapy methods help you work through root causes of addiction and develop coping skills to prevent relapse.
The most common methods include:
- Cognitive behavioral therapy
- Motivational enhancement therapy
- Contingency management therapy
Mutual/Peer Support
Many individuals in recovery from AUD find support in peer based groups. These organizations offer accountability and encouragement from likeminded peers and offer both in person and online options.
Popular support groups include:
- Alcoholics Anonymous (AA)
- SMART Recovery
- Celebrate Recovery
Aftercare
Each of the options listed above offer crucial aftercare for ongoing recovery. Through these sources or others, it is important to address key areas that affect ongoing health:
- Co occurring mental health disorders (anxiety, depression)
- Insomnia issues
- Nutrition
- Relapse prevention
- Medical follow up
Alcohol Tremors FAQs
Alcohol withdrawal shakes typically start six to 24 hours after the last drink, peak in 24-72 hours, and improve within three to five days.
Lingering tremors and anxiety may last a week or more. If symptoms escalate or new red flags arise, seek medical attention.
No. While it may appear to relieve symptoms, drinking more actually worsens the withdrawal cycle. It also increases seizure risk and the possibility of kindling.
The delay in sobriety also delays treatment and recovery. A safer approach is a medical assessment that determines what evidence based medications can be used to treat your withdrawal symptoms.
Call emergency services immediately in the case of seizures, severe confusion, hallucinations, very high pulse/blood pressure, high intensity headache, high fever or repeated vomiting.
Mild alcohol tremors can be managed at home only under clinician guidance, with a safety plan in place.
This plan must include daily check ins and proper fluid and nutritional intake and driving must be avoided. If symptoms worsen or if supervision is not reliable, it is crucial to escalate to urgent care or emergency services.
Find Treatment Near You
Treatment options for alcohol withdrawal tremors and alcohol addiction are available near you.
Not sure where to start?
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