Hands shaking/tingling the day after drinking: Alcohol withdrawal?
March 24, 2014 1:16 PM   Subscribe

I got drunk a couple days ago. Besides my hangover being horrendous (per usual), for maybe half the day my hands were slightly trembling and I couldn't get them to stop. They're doing better now, but my hands have never shaken before, and I'm worried that my drinking is starting to catch up with me. Would this be a reason to call the doctor, and if so are there any tests/checks I should ask to have done? Details inside.

One of my parents is an alcoholic, and the other used to be. I am close to my 30's, and would like to keep from becoming an alcoholic myself (although perhaps I already am).

As a result, I've tried to limit how often I drink. I rarely if ever drink alone, and drink at parties maybe once a month or so. When I do drink, however, I unfortunately tend to drink to excess and have a history of binge drinking.

I've struggled with anxiety my entire life, as have my siblings and one of my parents. This is one of the main reasons I have a hard time not binging when I am out being social: It calms me down and makes me feel less nervous. I also have a hard time saying no to another drink once I get started, especially if someone is pushing me to have one. Due to this bad habit, I've had more than a few instances where I have been inebriated to the point of blacking out/ making a fool out of myself/etc., which I try my best to avoid these days. I'm wondering, however, if the cumulative effects of my binge drinking in the past are starting to catch up with me.

It seems to take less and less to get me more drunk, and with worse hangovers. When I drank 2 nights ago I only had 3 beers. Granted, they were larger, higher alcohol content beers than your typical Budweiser so it was probably equivalent to a six pack or so. But still, compared to how I used to drink I was really taking it easy that night. Plus I ate a meal during, and had plenty of water before and after my drinking. And yet still the hangover was pretty bad.

When I was younger, I had what I would consider the "usual" hangover symptoms: headache, foggy head, maybe nausea if I happened to go too far. Now the symptoms are much worse, including a prickly tingling in my shoulder/arms for a day or so (I know alcohol can upset nerves). Also, a night out can mess up my mood for days, and I get more anxious.

But the shaking hands scared me the most, as I had never had this symptom before and I understand that it could be a sign of alcohol withdrawal. The trembling wasn't severe, but it was certainly noticeable when I would, say, pick up and hold a cup. Up to this point I didn't think that I drank often enough to go through withdrawal, but from what I've read recently binge drinkers can have more serious withdrawals than everyday alcoholics as the binge-er keeps forcing his/her body to switch between cold turkey, full-blown drunk and back again.

I'm not so sure how common my problem is, which is my primary reason for asking this question. In your opinion, would these symptoms be worrying enough to call the doctor? Has anyone had symptoms like the ones I am describint? If so, what kind of tests should I ask to have done? If I learn to be able to control myself, I'd like to be able to have a drink or two from time to time in social situations; but if I have already done enough damage to my body to the point that having a few drinks can exacerbate my current symptoms, I would consider completely abstaining from alcohol as well.

Sorry for the wall of text, and looking forward to your advice.

Sidenote: I also think my body processes alcohol more inefficiently than other peoples' bodies. Case in point: I once drank the same amount as a friend during the next point, and the next morning we try out his breathalyzer. His BAC is at 0, while I was still legally drunk.
posted by CottonCandyCapers to Health & Fitness (20 answers total) 1 user marked this as a favorite
Whether or not anyone else is in the same room when you are drinking doesn't mean anything.
While it is difficult to define "alcoholism", one of the typical features of it is a craving for more alcohol, and an inability to stop drinking, once you begin.

Yeah, I'd say it is definitely worrisome, and talking to a doctor is a good idea.
posted by thelonius at 1:23 PM on March 24, 2014

You wouldn't be going through physical withdrawal unless you're a daily drinker. The shaking is probably related to a combination of dehydration and anxiety about your drinking, I would imagine. Note that I am not a professional, but I'm in my late 30s and everyone I know has a worse reaction to alcohol than they did when we were younger. It's normal that your hangovers are worse than they used to be, even if you don't drink more.

I will also say, though - if you're worried about your relationship with alcohol, and you feel like you're able to stop right now, you should stop. My dad was an alcoholic, too. It's sad and terrible, how lifetime alcoholics end up. You don't want that for yourself.
posted by something something at 1:25 PM on March 24, 2014 [4 favorites]

You had three beers two days ago? Unless you had a super empty stomach and just the beers for dinner, I would say you're just old fashioned sick, and you should see a doctor under those premises alone.

See a therapist for the anxiety because that's the more longterm problem I'm reading into from my armchair.
posted by oceanjesse at 1:27 PM on March 24, 2014

Drinking is weird sometimes, and I definitely find as I settle into my 30s that I get more hangovers, and the effects of them are less predictable, than was the case in my 20s.

I don't really understand why you're so concerned that you are an alcoholic. Even "drinking to excess" is a bit strong. Three beers is "hm yeah I probably overdid it a little" territory, not DTs.

If you can stop drinking at three beers, you don't sound like you're having trouble controlling your drinking.

That said, if you feel shitty for days after a night of drinking, that would be enough to make me want to cut back. I've definitely cut out other types of totally socially acceptable substance use for similar reasons. You don't have to be a full blown alcoholic to decide that consuming a certain type of thing (whether it's chili dogs or triple espressos or cocaine) doesn't agree with you.

I sometimes get shaky hands when I'm dehydrated and/or have slept poorly. That sort of empty shitty hangover feeling also makes me feel overall sort of twitchy, like I've had one too many cups of coffee.

I think the tingling hands are worth talking to your GP about if it's a recurring thing and you can't just leave it at "more water and don't drink so much you sleep all weird".
posted by Sara C. at 1:31 PM on March 24, 2014

Sounds more like low blood sugar, which is very common after drinking alcohol. You don't develop physiological dependence on alcohol on 3 beers a month.

You do sound very anxious about your alcohol use though, and you may just be happier not drinking if this is an ongoing source of stress.
posted by tinkletown at 1:34 PM on March 24, 2014 [8 favorites]

Having to cut back your drinking as you get older is totally normal. Among most of my friends, this started to happen almost universally as we approached 30 as hangovers get worse and the sort of hangover blues can linger for days. I am always more anxious the day after drinking than I am otherwise.

That said, I agree that trembling hands after 3 beers seems strange and I doubt it is related to the alcohol withdraw. I would also guess it is more of an anxiety thing. If it wasn't severe and noticeable mostly when you were holding onto to something, there may also be a sort of vicious psycho-somatic cycle involved. I don't mean to imply that the trembling wasn't real, only that it may have been caused more by your anxiety about alcohol withdraw than actual alcohol withdraw. Like, you know how if you're really heart anxious, you can actually make your heart palpitate if you focus on it too much?

I'm not going to judge whether you have an alcohol problem or not, but to me it sounds like your anxiety about having an alcohol problem is much worse than your actual drinking. Now, that may be a good enough reason in itself to quit drinking. But I think your anxiety is the underlying problem. Of course, drinking, as my psychiatrist is fond of saying, is a highly efficacious short-term solution for anxiety, which is why so many anxious people drink a lot. But it isn't sustainable and will make anxiety worse in the long term.

As is often the case, your best course of action is probably to see a therapist and/or psychiatrist.
posted by Lutoslawski at 1:45 PM on March 24, 2014 [1 favorite]

I'd guess it's a blood sugar issue or your electrolytes are not in balance due to dehydration. You may be shaking, but as others have pointed out, alcohol withdrawal tremor requires much more drinking than what you're reporting.
posted by quince at 1:47 PM on March 24, 2014 [1 favorite]

Definitely see a doctor.
I'm fixated on your sidenote at the end - if you are somehow failing to metabolize the alcohol at all, it will remain in your blood stream until it happens to be removed by your kidneys (not that kidneys filter for alcohol, just that whatever the ratio is of alcohol:water in your blood will be the same in your urine, so it will eventually leave you).

I don't know if having a 3-beers-worth level of alcohol in your blood for prolonged periods can cause the symptoms you experienced, but I wouldn't just write it off as anxiety or blood sugar without making sure your liver is functioning.
posted by trivia genius at 1:50 PM on March 24, 2014 [1 favorite]

Thanks so far.

I don't mean to threadsit, but I'd like to reiterate that the hand shaking/hangover occurred the day after drinking (yesterday), and I'm totally fine today. Also, the average amount I drink is anywhere from 5-20, shots included. It's pretty variable as I tend to lose track and it depends on if I'm at a house party or out at a bar. It's not like I think I'm binging on 3 beers, and I would have had more than 3 but I had to leave early. Which is one of the reasons that I was surprised I had such a bad hangover in the first place.

I could definitely see anxiety as being a factor, but my anxiety has been much worse in the past and it's been getting better as of late so why now all of a sudden?
posted by CottonCandyCapers at 1:54 PM on March 24, 2014

20 drinks in one day can be considered very heavy drinking. Shakes the next day would be altogether in line with that. Mostly recovered the following day is nothing out of the ordinary. Yes, it sounds very much to me that your drinking is "catching up with you". What I eventually learned about hangovers is that they can be interpreted as a warning. Your body is very unhappy with what's going on. It (you) may be begging for a break. At some point in the alky cycle it no longer matters how much you drink, even one drink can bring on unpleasant symptoms. This is all spoken from my own experience, YMMV natch.
posted by telstar at 2:10 PM on March 24, 2014 [1 favorite]

The only reason NOT to go to a doctor and have them run some tests (liver panel, diabetes, blood pressure) is because you know what the doc is going to advise you when s/he hears that you are drinking those amounts -- that it's time to quit.

I think it's worth going in and having that conversation. If nothing else, it will give you a benchmark of your body's condition. Maybe you are in fact A-Ok, numbers-wise; maybe you are showing some worrisome numbers, but can arrest/correct the damage that's been done (or not). At least you will be acting with full knowledge of what is going on under the hood.

Re: moderation: since you have a pattern and practice of drinking to the point where you lose self-protective inhibition (blackouts) (and I'm not judging; been there, done that, but no more), it's safe to assume that it will be very difficult for you to drink just a few, over the long haul. Maybe you can maintain for a while, but then maybe (probably) shit will go sideways some night, and the consequences will be the too-predictable alcoholic dramas: injury, legal troubles, or worse.
posted by nacho fries at 2:22 PM on March 24, 2014 [2 favorites]

I would guess you are well on your way to moderately severe alcoholism--I would take the elevated BAC after 3 beers, your volume of drinking, shaking, blackouts, anxiety/concern about alcohol, etc as relatively clear and substantial evidence. Yes, you should see a physician and give some thought to if, when and how you may want to confront your alcoholism. While the shaking maybe a hypoglycemic reaction it is a moot point because it is almost certainly the alcohol that is causing spikes and blood sugar levels. Wishing you well
PS Not sure of your gender but women are much more susceptible to the early liver impairment--damage can reverse itself--to a point.
posted by rmhsinc at 2:53 PM on March 24, 2014 [1 favorite]

Your previous question indicates that you might be taking a new medication. Does your doctor know about your drinking habits? I'd recommend talking to your doctor about it if you haven't already.
posted by DarkForest at 3:19 PM on March 24, 2014 [1 favorite]

If you are on an anti-depressant, that will most definitely make your hangovers worse, because they (for most people) tend to amplify the effects of alcohol, so one drink may feel like 2.
posted by Lutoslawski at 3:49 PM on March 24, 2014

I can't believe I didn't think of the anti-depressant. I was on a different one before and didn't really notice a difference between my unmedicated and medicated hangovers, but maybe this new one is a different beast.

I do tend to obsess with and feel guilty about my drinking, so I might just say "#%@!" it and stop altogether for the duration of the med.

In the meantime, I think I'll call the doctor tomorrow and ask for a liver check just to be safe. Thanks, everyone.
posted by CottonCandyCapers at 4:12 PM on March 24, 2014 [2 favorites]

I want to note that alcoholics tend to underestimate their drinking. When a normal person says a drink they mean a 5-8% alcohol volume SMALL CAN of beer. Or 1 1 ounce shot. So if you had three large cans with a 12% alcoholic content, that is more like 8-9 drinks. And the time frame (you didn't mention in) makes a difference. If you drank it during dinner and a little after (5-9) that is 2 beers an hour. IF you drank them starting at noon until 2am, that is 14 hours. and at 8 drinks, that is closer to a half drink an hour. Neither is particularly good, but it effects how you metabolize it.

Get a medical work up. If your worried see a therapist as well. It sounds like you want to be healthy and are worried about consequences, so the best course of action is to not do it. And practice and experience in social settings without alcohol is the only way for your brain to learn you can enjoy yourself at a party without it!
posted by AlexiaSky at 5:11 PM on March 24, 2014 [1 favorite]

I drank very similar to you. I stopped in January after an absolutely terrible night. It was the best decision I have ever made. I got the help and support that I needed. This help and support looks different to everyone. I would recommend that you start by talking with your doctor, therapist, or someone that may know more about resources you could explore. A therapist or psychopharmacologist would be of help to let you know what your options are with regard to treatment. Whatever it is, it has to be right for you and you have to want to do it.
posted by Jewel98 at 5:42 PM on March 24, 2014 [3 favorites]

I'm a recovering alcoholic. I come from a long line of distinguished drunks. I believe it is partly heredity.
May of the things you said - taking less to get you drunk, waking up the next day still drunk, not being able to stop after having a few, sound very very familiar. Yes, sometimes I could stop after a few, but mostly not. Controlling my drinking wasn't much fun anyway.
Ask yourself if most people think about controlling their drinking. How many "loose track" of how much they drank? Think about the the statement I've heard many times - "Bad things didn't happen every time I drank, but every time bad things happened, I'd been drinking."
I started out as a binge drinker, but the binges started getting closer together.
One thing I refused to hear from the docs is that the anti-depressants I was taking (SSRI) wouldn't work very well if I drank. I was depressed most of the time. My depression first manifested as anxiety, I was mis-diagnosed for a while. Now, I only take the meds at high stress periods at work. Which is now that place where I am respected and get raises I did not ask for, as opposed to the job I'm only going to have for a few years because I'll get canned.
What I have written is what happened to me, not you. Only you can decide if you are an alcoholic.
posted by rudd135 at 7:36 PM on March 24, 2014 [2 favorites]

Shaking after drinking doesn't seem like a big deal. When I've gotten super wasted, I've been a bit shaky, sensitive to noise, lethargic, achey and whatever else the next day. The one time in my life I blacked out, I could barely function the next day. Seems totally normal to me. I feel like you're overthinking this, unless you were shaking badly.
posted by AppleTurnover at 9:04 PM on March 24, 2014

but I wouldn't just write it off as anxiety or blood sugar without making sure your liver is functioning.

One of the reasons alcohol messes with your blood sugar levels so much is because it impairs liver function, which plays an important role in regulating blood sugar. Liver problems and blood sugar problems could be related.
posted by sam_harms at 10:14 AM on March 25, 2014

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