A tremor, or uncontrolled shaking, is one of the visible symptoms of alcohol withdrawal. Long-term alcohol addiction can also lead to brain damage that causes a noticeable tremor. Severe liver damage from alcohol abuse can cause a specific kind of flapping tremor called asterixis.
Uncontrolled shaking of the hands or other parts of the body is common among those suffering from an alcohol addiction. Most of the time, an individual with a drinking problem who shakes is exhibiting signs of alcohol withdrawal, but there are other reasons why an alcoholic might shake.
As a central nervous system depressant, alcohol slows brain activity and reduces energy levels. But when someone consumes large amounts of alcohol regularly, their body adapts to the continuous presence of alcohol.
To compensate for the sedative effects of alcohol, the brain releases more excitatory neurotransmitters than normal, which ramps up nerve activity and keeps the body in a more awake state. These changes in brain chemistry are part of the reason why long-term heavy drinkers often don’t appear drunk.
But when a chronic drinker suddenly quits drinking, the brain continues to function as if alcohol were present. In this amped-up state, an individual will begin to feel the symptoms of withdrawal, such as tremors, anxiety, sweating, hyperactivity, an elevated heart rate, nausea and vomiting.
Tremors and other symptoms of alcohol withdrawal can occur as soon as six hours after someone last had a drink. That’s why some alcoholics wake up shaky in the morning and need a drink to feel steady.
Some people can develop a severe form of alcohol withdrawal known as delirium tremens, or DTs, that can cause a severe shaking or shivering. Other symptoms of DTs include hallucinations, agitation, high blood pressure, fever and even seizures. Because delirium tremens can be fatal, it’s often recommended that individuals withdrawing from alcohol undergo a medically monitored alcohol detox.
While these tremors can be very uncomfortable and frightening, they should subside in time. Symptoms of alcohol withdrawal typically peak within 10 to 30 hours and usually subside within 40 to 50 hours, although some people develop a protracted alcohol withdrawal syndrome that can last up to a year.
According to the Practical Neurology journal, frequent and excessive alcohol consumption can also damage the cerebellum, an area of the brain located near the top of the brain stem that regulates balance, coordination and fine motor movement.
Alcohol-related damage to the cerebellum can result in what’s known as an intention tremor. An intention tremor is a certain type of trembling that is most noticeable when a person makes purposeful or goal-oriented movement toward an object, but the tremor may also be present at rest.
Other symptoms of alcohol-related cerebellar dysfunction can include poor coordination and balance, clumsiness, an unsteady walk and involuntary back-and-forth eye movements known as nystagmus. Some individuals also develop damage to the peripheral nervous system, which may cause muscle weakness, numbness, tingling and burning pain in their extremities known as peripheral neuropathy. This can contribute to falls.
Damage to the cerebellum from drinking usually takes about 10 years to occur and shows up on an MRI as shrinkage in the cerebellum. It is believed to be caused by the toxic effects alcohol has on the brain plus nutritional deficiencies (particularly of the B vitamin thiamine) common in alcoholism.
Once symptoms of alcohol-related brain damage occur, they will continue to worsen if drinking continues. The only way to prevent a worsening of symptoms is to quit drinking, although this should not be attempted without professional help.
Alcoholism can also lead to liver disease, which, in its advanced stages, can cause a characteristic flapping or shaking of the hands known as asterixis.
While there may be few noticeable symptoms in early liver disease, prolonged liver dysfunction can cause a number of complications, including a potentially fatal brain disorder known as hepatic encephalopathy (HE).
Hepatic encephalopathy develops when the liver is unable to effectively filter toxins that can harm brain cells from the blood. As these toxins — which include ammonia, manganese and other substances — build up in the brain, the individual begins to experience sleep disturbances, mood changes and problems with motor control, including a flapping tremor.
Also called “liver flap,” the flapping tremor is best observed when the person’s hands and wrists are extended outward as someone pushes back on their hands, according to the Journal of Neurology, Neurosurgery and Psychiatry. The phenomenon, which is usually present in the early stages of hepatic encephalopathy and is called asterixis, is sometimes compared to a bird flapping its wings.
Some individuals may develop a tremor similar to the one experienced by individuals with Parkinson’s disease.
While hepatic encephalopathy can also lead to coma and death, the condition usually resolves with treatment.
Nevertheless, the development of HE is an ominous sign. According to research published in the Journal of Neurology, Neurosurgery, and Psychiatry, approximately half of patients with cirrhosis of the liver die within one year of their first episode of HE, and 80 percent die of liver failure within five years.
If you are a heavy drinker and are experiencing a tremor or shakiness, you should consult with your physician or an addiction specialist.
Shaking that occurs when you go without a drink for several hours can mean you have a physical dependence on alcohol and are suffering from withdrawal. Less commonly, it can be sign of brain damage or liver disease. Whatever the cause, shaking should not be ignored.