One of the possible and most severe side effects of withdrawal from alcohol are shakes or tremors. Read on to learn more about what this is, the cause, what can be done about them and possible treatment.
What Are Alcohol Shakes?
Those who consume moderate quantities of alcohol may not have the shakes when they stop drinking. However for chronic drinkers who abruptly stop using alcohol, Alcohol Withdrawal Syndrome (AWS) typically is felt within 3-8 days as tremors (shakes), mild anxiety, headache, abdominal discomfort, and insomnia. Tremors are an involuntary shaking of the hands, legs or other parts of the body.
But 3-5% of those with AWS progress to AWD, formerly known as delirium tremens (the DTs). AWD symptoms include fever, irregular heartbeat, agitation, profuse sweating, hallucinations, disorientation and hypertension. Mild symptoms may progress to alcohol hallucinosis with visual or auditory hallucinations that usually subside within 48 hours after stopping alcohol. Epileptic-like withdrawal seizures can occur within just a few hours of stopping alcohol. And severe cases of AWD can lead to urgent life-threatening complications and prove fatal. [1]
What Causes Alcohol Shakes?
The simple explanation is that tremors are caused by a temporary or permanent impairment in the cerebellum and motor cortex of the brain. If these two areas don’t function properly a person may experience tremors or even uncontrollable seizures. Tremors often affect those with neurological conditions, like muscular dystrophy or cerebral palsy.
From a more clinical perspective, alcohol is a central nervous system depressant that when consumed heavily, works by producing an excess of the neurotransmitter GABA. This results in sedation, euphoria and a loss of inhibition. Chronic alcohol use changes the balance of GABA and glutamate, another excitatory transmitter. This causes an excess of glutamate to be produced to balance the influx of GABA provided by alcohol.
When someone stops consuming alcohol, the GABA signal is suddenly diminished resulting in an excess of glutamate. This makes the brain hyperactive. The excess causes the effects of AWS and with it the shakes or tremors.
Alcohol shakes are frequently accompanied by night sweats when an alcoholic is going cold turkey. This is because alcohol simultaneously depresses and stimulates the nervous system.
What Can You Do to Stop Alcohol Shakes
Chronic drinkers with the shakes should not try to treat themselves due to the medical risks involved. Here is the range of treatments commonly used:
As an Outpatient
In a medical outpatient setting, mild AWS can be treated using benzodiazepine (Valium or Xanax among others) in a tapering dose to avoid addiction to them. Benzodiazepines are depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms and reduce seizures. Another medication is gabapentin which interferes with abnormal electrical activity on the brain that causes seizures.
Inpatient treatment
In a hospital setting, the depressant benzodiazepines Diazepam or Lorazepam or the barbiturate phenobarbital,are administered.
Vitamins
Thiamine and folate supplements are also given to compensate for nutritional deficiencies due to chronic alcohol use.
Electrolytes
Due to severe dehydration with AWS, electrolytes such as magnesium and phosphorus should also be given together with a glucose drip to restore healthier hydration levels.
Long-term Medications
The underlying Alcohol Use Disorder needs to be addressed with therapy and with medications if required. These include opioid antagonists such as naltrexone, which binds and blocks opioid receptors and reduces and suppresses alcohol cravings and Disulfiram (Antabuse) inhibits the liver from processing alcohol and heightening the negative effects of drinking alcohol,
Alcohol Withdrawal Delirium
Delirium requires treatment and close monitoring, often in intensive care settings. This is so especially after a patient has received high doses of benzodiazepines or phenobarbital.
Treatment to Properly Recover From Alcohol Addiction
Going “cold turkey” to overcome alcohol addiction is not recommended because it’s dangerous and almost never works. Trying to simply stop the shakes will not address the underlying emotional issues behind the alcohol abuse. Enrolling in a residential treatment program with medically supervised detox is the safest, most effective strategy.
Overcoming addiction is a multifaceted process involving the following elements:
- Medically-Assisted Detox: Detoxification is best done under medical supervision in a licensed detox facility. Healthcare professionals can monitor your progress and administer medications to ease withdrawal symptoms.
- Behavioral Treatments: Various forms of therapy and counseling can best help guide you through withdrawal and into maintaining sobriety. These include individual psychotherapy, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), among others. This may be done privately but is often best done in a residential treatment center or Intensive Outpatient Program (IOP).
- Medications: Three medications are currently approved in the US to help people stop or reduce drinking. They are prescribed by a doctor or other approved healthcare practitioner.
- Support Groups: AA, SMART and other support groups offer peer support for people cutting back or quitting their drinking.This is often combined with therapy to gain the best range of support.
Seeking Professional Help
If you or someone you know is showing signs of addiction or mental health issues, reach out for help. Compassionate licensed addiction specialists are available at The Encino Recovery & Detox Center. Remember, taking the first step towards recovery is a sign of strength. With the right support and treatment, overcoming addiction is possible, paving the way to a healthier, more fulfilling life.
Sources
[1] Canver BR, Newman RK, Gomez AE. Alcohol Withdrawal Syndrome. [Updated 2024 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-
