Why Does Alcohol Cause the Shakes?

Dr Peter McCann


This article is medically reviewed by Dr Peter McCann, MSC, MBBS. Dr McCann is a is a Psychiatry and Internal Medicine Resident at Duke University Hospital, USA.



What are ‘the shakes’ and what causes them?

The ‘alcohol shakes’ is a term to describe tremors caused by Alcohol Withdrawal Syndrome, which occurs in some frequent alcohol users when they suddenly stop drinking. 

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It is part of a condition called alcohol withdrawal syndrome that occurs in around 50% of people with heavy alcohol use. In the mild form, typical symptoms other than tremor include anxiety, sweating, nausea, restlessness, headaches and alcohol craving. More severe forms of withdrawal can result in seizures, delirium tremens and hallucinations – and without treatment can lead to death.

Why do I shake after drinking alcohol?

It’s not actually the presence of alcohol that causes the shakes or tremors, but the sudden absence of alcohol in the body when the body has become used to its presence.

Withdrawal symptoms are a result of physiological imbalances which happen after a prolonged period of heavy drinking.

What’s the science behind alcohol shakes?

Alcohol has a depressant effect on the body, and heavy consumption can lead to the brain becoming used to a reduced level of stimulation. In more scientific terms, alcohol reduces activity of the central nervous system, by increasing the activity of the main inhibitory (depressant) neurotransmitter gamma-aminobutyric acid (GABA).

In response to the chronic increase in GABA activity, the brain reduces the number of GABA receptors in parts of the brain, in order to compensate.

When alcohol leaves the body, the brain has less of the depressant effect of alcohol but also fewer of the depressant GABA receptors because of the now reduced number. This leaves the brain in an overall excited state and this is what causes the tremors or shakes. 

Are alcohol shakes serious?

Having the shakes can be irritating and embarrassing, but isn’t serious in itself. It is however a sign of alcohol withdrawal which in some patients can lead to much more serious consequences. It is also a strong indication that the person has a severe alcohol use disorder.

Complicated alcohol withdrawal can lead to hallucinations, seizures or “delirium tremens” – a medical emergency that requires specialist inpatient care.

Alcohol shakes can occur after a few hours after drinking, and alcohol withdrawal seizures typically occur between 6 and 48 hours after stopping or reducing drinking. After 48-72 hours they may get delirium, which can cause death.

What is delirium tremens?

Delirium tremens is a neurologic syndrome resulting from and marked by changes in mental status and autonomic nervous system excitation. Symptoms may include confusion, anxiety, fever, body tremors, rapid heartbeat, sweating, severe confusion, agitation, hallucinations, and high blood pressure.

Alcohol withdrawal delirium has a high mortality rate – of about 8% – and so it is important that people are treated in a safe and secure environment, by clinicians who understand the condition.

What medications treat alcohol shakes?

When alcohol shakes and tremors become more than just a bad hangover and are signs of alcohol withdrawal, clinical interventions are needed.

Medicines called benzodiazepines can lessen alcohol withdrawal symptoms, and commonly include chlordiazepoxide (Librium) and lorazepam (Ativan). These drugs are typically used to treat anxiety, seizures, and sleep disorders due to the calming effect that they have on the nervous system.

In a residential detox and rehab centre, the withdrawal process is carefully monitored by medical staff, to minimise potential risks. The process of detoxification involves weaning a person from a substance in a safe and effective manner, by gradually tapering out its use. This minimises the withdrawal symptoms and helps prevent complications.

How long do shakes from alcohol withdrawal last?

The duration and severity of withdrawal symptoms vary depending on how much someone drinks, for how long, and how regularly. Other factors such as age, gender, weight and family history of addiction also have an impact.

It’s important to realise that if you have the shakes when you stop drinking, it’s a sign that your body has become dependent on alcohol, and that’s a sign that it’s time to get help.

What’s the safest way to treat someone who has alcohol shakes?

Because of the risk of delirium tremens – and the fact it can cause death – if someone suffers from severe alcohol shakes it’s important to seek a safe, medically-led detoxification programme, where your symptoms can be managed carefully.

Alcohol detox and rehab

The safest way to detox from alcohol if you have been drinking heavily for a long time is under the care and guidance of trained medical professionals in a detoxification unit or in a residential rehab hospital that has 24/7 nursing care and a 24/7 onsite doctor.

The medical staff will ensure that you receive a slow, safe, supervised detoxification from alcohol at a rate that is comfortable for you and they will be able to support you through the side effects of alcohol withdrawal. 

Once you have finished detox you will be able to join in the therapy programme and begin your recovery into a life free from alcohol.

At Castle Craig, we offer 24/7 nursing support with an onsite doctor in our specialist detoxification unit. Once detoxed patients join the main therapy programme which is based on the world-renowned 12 Step model of treatment, which is abstinence-based.

Through the programme, you will join in group and individual therapy to tackle your addiction and underlying mental health issues, such as trauma, that are contributing to the desire to drink alcohol. By joining in a programme like this you will eventually be able to leave alcohol behind and begin a new life in recovery. 

Learn more about how to detox from alcohol safely

Real-life story

I started worrying when I was still working in a bakery at the age of 21. I started noticing that every day around the end of my shift I got really anxious and shaky. I knew from the start it was because of a lack of alcohol in my system. Yet I kept drinking as soon as my shift was over. I now realize I should’ve stopped there but I was scared of the withdrawal so I didn’t. That was a mistake back then.

Years later when I was 28 years old, I knew I had a serious problem for some years but I was too scared to admit it. One evening when I was thinking about my future I thought to myself… When I grow up I want to be…

Then I realised I was already grown up. And I should’ve been there already. I made the choice then and there that I was going to quit the bottle and get my life together. I didn’t yet know-how. I talked to my girlfriend about it and she didn’t support it. She wanted us to keep drinking and having fun. For me, the fun had been over for a long time.

If you worried about yourself or a loved one and want advice on residential alcohol detoxification contact our Admissions Department who will be happy to answer your questions.

For more help and advice about rehab please call our 24-Hour Helpline: 01721 728118

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