Alcohol Shakes: What Are They and Why Do They Happen?
Many are familiar with the side effects of a hangover after a night of heavy drinking. In the short term, this is not such a big deal, but as drinking continues, what about the adverse physical effects? Should you be worried about your loved ones’ shaking hands? They seem to have a hard time controlling their movements. Is it a sign your loved one has an alcohol use disorder?
Californians are no strangers to excessive and chronic alcohol use. Between 2020 and 2021, an average of almost 19,000 adults aged 20 and over died from excessive alcohol use. What if they knew the physical signs that alcohol was taking its toll? Could these deaths have been prevented?
Alta Mira provides educational resources for those wanting to learn more about alcohol and substance use. In this article, we are answering the question: “What are alcohol shakes?”
Understanding Alcohol-Related Tremors
Alcohol is a psychoactive depressant that modulates brain activity, resulting in the suppression of central nervous system function. Although low to moderate alcohol consumption does not typically induce tremors, individuals who engage in heavy alcohol use and subsequently experience withdrawal are at significant risk for developing motor tremors. These tremors, commonly affecting the hands, can substantially impair daily functioning. While the reintroduction of alcohol temporarily alleviates these tremors, recurrent withdrawal episodes increase the risk of provoking their resurgence.
A study investigated alcohol-related tremors in comparison to essential tremor, a distinct neurological condition. Participants with chronic alcohol use abstained from alcohol for a 21-day period. The study found that 47% of these individuals exhibited postural tremors, a type of action tremor occurring during voluntary muscle movements. Notably, these tremors were never severe, and only 17% of the alcohol-consuming group reported functional disability. Furthermore, only 1% of participants in the alcohol-related tremor group had a family history of tremors, in contrast to 46% of individuals with essential tremor. The study concluded that alcohol-related tremors differ fundamentally from essential tremor, indicating that the two conditions are distinct in their etiology and clinical presentation.
Distinguishing Alcohol Shakes from Delirium Tremens
Both alcohol tremors and delirium tremens (DTs) are associated with alcohol withdrawal, though they represent different levels of severity. Tremors, often accompanied by other withdrawal symptoms, are a common manifestation in individuals who have engaged in prolonged heavy alcohol consumption. In contrast, research shows delirium tremens (DTs) involve a more severe and potentially life-threatening form of withdrawal. Although rare, DTs necessitate urgent medical intervention due to their serious complications. Clinical features of DTs include hallucinations, delirium accompanied by agitation, and seizures, which can pose significant risks to the individual’s health and safety.
Etiology of Alcohol-Induced Tremors
When alcohol is consumed, various areas of the brain are affected, leading to subsequent effects on the central nervous system. The cerebellum (responsible for movement), amygdala (controls emotion regulation), and prefrontal cortex (controls decision-making), are the main areas where alcohol causes hindrances. Recent studies show that alcohol, both in the short and long term, impacts specific channels in brain cells that control how active those cells are. These effects go beyond how alcohol influences communication between brain cells (synapses) and also alter the cells’ basic activity levels.
These changes occur as the brain’s way of adapting to alcohol’s presence. Therefore, when alcohol is no longer present, communication between brain cells becomes confused. The result is withdrawal symptoms, in which tremors stem from the increased excitability of the central nervous system. The brain directly signals this due to the alteration of the cells’ activity levels.
Alcohol Withdrawal Symptomatology
Alcohol withdrawal symptoms carry a high variability with dependent factors such as metabolism, length of time drinking, and amount of alcohol consumed per sitting. Common symptoms experienced include:
- Hand and body tremors
- Increased sweating
- Nausea and vomiting
- Insomnia
- Increased agitation
- Anxiety
- Increased body temperature
- Gait disturbances
- Tachycardia
The timeline of alcohol withdrawal is complex, with ongoing research aiming to elucidate the precise onset and progression of symptoms. Mild alcohol withdrawal typically begins approximately six hours after the cessation of alcohol consumption and is characterized by motor and autonomic symptoms. This phase generally resolves within 48 hours. Moderate alcohol withdrawal, which includes psychiatric manifestations such as hallucinations, also begins around six hours post-ingestion and persists for approximately six days.
Severe alcohol withdrawal is marked by acute symptomatic seizures, often commencing within 4 to 6 hours after the last drink. This stage is associated with significant psychiatric disturbances, and by the 48-hour mark, the risk of developing delirium tremens (DTs) becomes elevated. In cases where DTs occur, symptoms may persist for up to 14 days, necessitating prompt and intensive medical management.
Chronic alcohol consumption coupled with recurrent episodes of withdrawal significantly elevates the risk of developing severe medical conditions. Prolonged exposure to alcohol results in cumulative neurological and hepatic damage, exacerbating adverse outcomes. These effects include permanent tremors and other debilitating symptoms, which can profoundly impair an individual’s quality of life and functional capacity.
Alcohol-Associated Neurological Damage
A widely known yet under-diagnosed condition associated with chronic alcohol consumption is Wernicke-Korsakoff syndrome. The condition is divided into two separate diagnoses – Wernicke encephalopathy (WE) and Korsakoff syndrome (KS). WE is an acute neuropsychiatric disorder whereas KS is a chronic condition involving severe cognitive impairment and memory formation. Both are the result of a thiamine (vitamin B1) deficiency.
Studies have shown that chronic alcohol consumption contributes to thiamine deficiency through multiple mechanisms:
- Inadequate dietary intake: Individuals with chronic alcohol use often consume diets high in carbohydrates and low in essential vitamins, depleting thiamine stores within 2–3 weeks without supplementation.
- Reduced gastrointestinal absorption: Alcohol impairs thiamine absorption in the gastrointestinal tract, further exacerbating deficiency.
- Increased renal excretion: Alcohol affects renal function, leading to enhanced urinary excretion of thiamine.
- Hepatic storage impairment: Chronic liver disease associated with alcoholism diminishes the liver’s thiamine storage capacity by approximately 73%.
- Enzyme inhibition: Alcohol reduces the activity of thiamine pyrophosphokinase (TPK), a critical enzyme necessary for converting thiamine into its active form, thereby limiting cellular uptake.
- Gut microbiota disruption: Alcohol interferes with the absorption of thiamine synthesized by gut microbiota.
- Magnesium deficiency: Chronic alcohol use is often accompanied by magnesium deficiency, which impairs the biological functionality of thiamine, as magnesium serves as a cofactor for thiamine-dependent enzymes.
These factors collectively compromise the body’s ability to absorb, store, and utilize thiamine, creating deficiency and increasing the risk of WE and KS. Symptoms include motor disabilities affecting gait, eye muscle impairment, speech muscle loss, and memory impairment. Administering thiamine and refraining from alcohol consumption reduces the symptoms of WE, though permanent brain damage can occur. KS is a severe progression of the condition, and permanent amnesia with cognitive impairment is irreversible.
Tremors Attributable to Hepatic Dysfunction
Liver dysfunction from chronic alcohol consumption has a direct effect on the brain. A condition known as hepatic encephalopathy (HE) is a serious and life-threatening result of alcohol-related liver disease. Symptoms of HE include sleep disturbances, mood alterations, severe cognitive changes such as losing attention span, anxiety, depression, and asterixis – a specific flapping hands type of tremor.
Asterixis is an involuntary, brief flapping movement that predominantly affects the muscles of the arms, though it can also involve other muscle groups. It is usually bilateral, though it can occur unilaterally in some cases.
To test for asterixis, clinicians generally instruct the individual to extend their arms, dorsiflex their wrists, and spread their fingers while closing their eyes. A brief, irregular “flap” or flexion of the wrist indicates a positive result. The sensitivity of the test can be enhanced by gently applying pressure to the individual’s hands. Receiving a positive result for asterixis indicates further testing is necessary to ensure HE is properly managed.
Getting Treatment for Alcohol Use Disorder in Sausalito, CA
Experiencing alcohol tremors is a sign that something more serious may be going on, but stopping alcohol use may feel impossible right now. Alcohol rehab will give you the tools needed to leave alcohol behind and take back control of your physical and mental health. Guided therapies, skill-building courses, and physical evaluations will all be a part of your path to recovery. Don’t let alcohol take over any longer – reach out for help today.
Alcohol can cause serious harm to your or your loved one’s overall well-being. Alta Mira understands how crucial it is to address every aspect of alcohol use disorder, which is why we provide physical, mental, and psychological assessments throughout the treatment process. Our program combines evidence-based therapies and holistic practices to round out the whole-person approach. Call us today at 866-922-1350 to learn more about our program offerings.
Alta Mira: Science-backed treatment, world-class care
Sources
Butterworth, Roger F. “Hepatic Encephalopathy— A Serious Complication of Alcoholic Liver Disease.” PubMed Central, https://pmc.ncbi.nlm.nih.gov/articles/PMC6668889/. Accessed 23 December 2024.
Grover, Sandeep, and Abhishek Ghosh. “Delirium Tremens: Assessment and Management.” Journal of Clinical and Experimental Hepatology, vol. 8, no. 4, 2018, pp. 460-470. Science Direct, https://www.sciencedirect.com/science/article/abs/pii/S0973688318300562. Accessed 2024.
Isenberg-Grzeda, Elie, et al. “Wernicke-Korsakoff-Syndrome: Under-Recognized and Under-Treated.” Psychosomatics, vol. 53, no. 6, 2012, pp. 507-516. Science Direct, https://www.sciencedirect.com/science/article/pii/S0033318212000771. Accessed 2024.
Harrison NL, Skelly MJ, Grosserode EK, Lowes DC, Zeric T, Phister S, Salling MC. Effects of acute alcohol on excitability in the CNS. Neuropharmacology. 2017 Aug 1;122:36-45. doi: 10.1016/j.neuropharm.2017.04.007. Epub 2017 May 4. PMID: 28479395; PMCID: PMC5657304.
Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A. and Ludolph, A. C. (2017), Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135: 4–16. doi: 10.1111/ane.12671
Zackria R, John S. Asterixis. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023. PMID: 30571066.
