Long, sleepless nights. Drifting in and out of consciousness in fits of confusion. Waking up drenched in sweat, someone who suffers from alcoholism understands the horror of reaching frantically for a bottle to stop the unease of alcohol withdrawal. They keep a bottle of vodka under the bed, hidden in drawers, the garage, or any other place a bottle could be kept. In these moments, nothing matters more than stopping the pain with a couple of swigs of booze.

Before the drink, the hand can’t stop shaking, making it difficult even to take a drink. They may be hearing or seeing things that aren’t there. Vomiting becomes a regular occurrence. This is the normal life of someone severely dependent on alcohol. This is life with DTs (delirium tremens).

About 5% of people who withdraw from alcohol will experience hand shakiness, seizures, or delirium (impaired cognition and hallucinations), or a combination of these symptoms. These are life-threatening medical conditions.

If someone is afraid that abstaining from alcohol may result in these extreme withdrawal symptoms, medical supervision is necessary. There is no shame in seeking professional medical assistance to quit drinking. It is a brave and courageous decision that will improve the quality of life for the drinker and the family.

Alcoholism and Withdrawal

Alcoholism, or alcohol use disorder (AUD), is responsible for an estimated 88,000 deaths every year in America. Alcohol-related deaths account for the third most deaths by preventable disease. Alcohol depresses the central nervous system. It enhances neurotransmitters that govern inhibition and simultaneously flooding neurotransmitters that lead to increased excitement. This is the scientific description for feeling drunk.

In America, over 20% of men and 10% of women will develop an AUD at some point in their lives. Someone is diagnosed with AUD if they experience alcohol-related problems in at least two of the eleven categories as outlined in the DSM-V. AUD shortens life-expectancy by at least 10 years, and people with alcoholism experience devastating health impairments and social isolation.

More than 16 million people in America suffer from AUD. Alcohol withdrawal can begin in as little as 8 hours from the last drink and can last for more than 8 days. Symptoms of alcohol withdrawal range from mild to severe, and they can result in death. The most common withdrawal symptoms include:

Anxiety
Shaky hands
Headache
Nausea
Vomiting
Insomnia
Sweating

Withdrawal symptoms are physical signs of untreated AUD. Aside from these, other physical signs of AUD range from swelling in the legs, jaundice or yellowing skin, itchy skin, bloody vomit or stools, and loss of alcohol tolerance. If you or a loved one is experiencing one or more of these physical signs of withdrawal or alcohol dependency, help is available. Medically supervised detox is the best place to begin the journey towards alcohol recovery and treatment.

Alcohol Shakes and Delirium Tremens

Delirium tremens was first linked to alcohol withdrawal in 1813. DTs occur in as little as 48 hours after someone’s last drink and can last for five days. Without medical treatment, over 35% of people going through DTs alone are expected to die.

At home, alcohol is the only solution to ward off alcoholic tremens, delirium, or seizures. Unfortunately, when someone’s alcoholism has gotten this bad, drinking continues to make them more dependent on alcohol while temporarily relieving withdrawal symptoms. Death and long-term health complications can result from the seizures, and stories of people falling and dying during alcohol delirium tremens have been documented.

Someone is at higher risk for DTs if they have experienced alcohol withdrawal previously, have a prior history of seizures, have concurrent illnesses, have detoxed from alcohol before, and have the time since the last drink. It is important when deciding to detox from alcohol that a doctor is given the trust needed to ensure a safe detoxification process.

Stopping Drinking

Quitting alcohol is one of the most challenging habits to cut out of someone’s life. Alcohol is everywhere. From walking through grocery store aisles to having a romantic dinner in a restaurant, alcohol is everywhere even when it’s being avoided. Drinking booze is as American, in many ways, as apple pie and football. Sometimes, even regular drinkers can feel like they’ve been drinking too much. Besides the day-after hangover, most drinkers will never experience symptoms of alcohol withdrawal.

The most feared symptom of alcohol withdrawal are the shakes and delirium tremens. When a person has become addicted to alcohol, drinking becomes more important than family, friends, jobs, and health. When drinking becomes seemingly impossible to quit, hope may be right around the corner. If you or a loved one wants to stop drinking, or fears they are physically dependent on alcohol, the recovery experts at Boardwalk Recovery are eager to answer any questions or concerns you may have.

Frequently Asked Questions

How long do alcohol shakes last?

Alcohol shakes typically begin within 5 to 10 hours after the last drink, peak around 24 to 48 hours, and resolve within 2 to 10 days for most people — though those with severe or long-term dependence can experience tremors that persist for several weeks beyond that. The duration and intensity depend heavily on how long and how heavily a person has been drinking, whether they have gone through withdrawal before, and their overall physical health. Mild shakes confined to the hands are common in early withdrawal and usually subside within the first week. Shakes that worsen after 48 hours, spread to the full body, or come with confusion and hallucinations are a medical emergency and require immediate professional attention.

Why does alcohol cause shakes and tremors?

Alcohol shakes happen because chronic heavy drinking fundamentally alters the brain’s chemical balance, and when alcohol is removed, the nervous system goes into overdrive. Alcohol enhances the calming neurotransmitter GABA while suppressing the excitatory neurotransmitter glutamate — and over time, the brain compensates by reducing GABA sensitivity and amplifying glutamate activity to maintain equilibrium. When drinking stops suddenly, that compensatory hyperactivity has nothing to offset it, and the result is an overexcited nervous system that produces involuntary tremors, rapid heart rate, anxiety, and sweating. The shakes are, in essence, the brain losing its brakes.

What is the difference between regular alcohol shakes and delirium tremens?

Regular alcohol shakes are typically limited to the hands and fingers, begin within hours of the last drink, and while uncomfortable, are not immediately life-threatening. Delirium tremens (DTs) is a far more severe and potentially fatal condition that usually develops 48 to 72 hours after the last drink and involves full-body tremors, profound confusion, hallucinations, fever, dangerously elevated heart rate and blood pressure, and in some cases seizures. DTs affect roughly 5% of people going through alcohol withdrawal, but without medical treatment, the fatality rate among those who develop it is estimated at over 35%. If shakes are accompanied by confusion, seeing or feeling things that aren’t there, or a rapid and irregular heartbeat, call 911 — this is a medical emergency.

When do alcohol withdrawal symptoms peak?

For most people, withdrawal symptoms — including shakes, sweating, anxiety, and nausea — peak somewhere between 24 and 72 hours after the last drink, then gradually begin to subside. The early phase of withdrawal (6 to 24 hours) typically brings milder symptoms: trembling hands, headache, nausea, and agitation. The peak danger window runs from 24 to 72 hours, when the risk of seizures and the onset of delirium tremens is highest. By days four through seven, symptoms begin resolving in most cases, though psychological symptoms like anxiety and sleep disruption can linger considerably longer as part of post-acute withdrawal.

Can you detox from alcohol at home?

Detoxing from alcohol at home is genuinely dangerous for anyone with significant physical dependence, and is not recommended without medical guidance. Unlike withdrawal from most other substances, alcohol withdrawal can kill — DTs and seizures can develop even in people who initially feel their symptoms are manageable, and they can escalate very quickly. The risk is especially high for people who have been drinking heavily for years, have detoxed before, have concurrent health conditions, or are older. A person who has experienced shakes, anxiety, or nausea when they’ve gone without a drink is already showing signs of physical dependence that make unsupervised withdrawal risky. The safest approach is always to involve a medical professional before stopping, so that the appropriate level of support can be arranged.

What happens after detox — is treatment for the addiction itself available?

Medical detox addresses the physical crisis of withdrawal, but it is the beginning of recovery, not the end. Once the body has stabilized, the deeper work of addressing the emotional, psychological, and behavioral dimensions of Alcohol Use Disorder can begin in earnest. At Boardwalk Recovery Center, we provide a structured path directly from detox into treatment, including our Intensive Outpatient Program (IOP), individual therapy, evidence-based approaches like CBT and EMDR, dual diagnosis support for co-occurring mental health conditions, and experiential therapies. Detox without follow-on treatment is associated with high rates of relapse — combining the two dramatically improves long-term outcomes. If you or someone you love is navigating alcohol withdrawal, we’re here to help with the full journey.