Studies, however, have not shown benzodiazepines as effective treatment for what are called the core PTSD symptoms of avoidance, hyper-arousal, numbing and dissociation. In fact, the drugs may impede other effective treatments for PTSD. Mounting evidence suggests that the long term harms imposed by benezodiazepine use outweigh any short term symptomatic benefits in patients with PTSD. Studies that compared the use of a benzodiazepine called Alprazolam and a placebo for alleviating PTSD symptoms, found that the slight reduction of anxiety was offset by withdrawal symptoms after only five weeks of use. The use of benzodiazepines is especially problematic in PTSD patients who also have substance abuse disorders or mild traumatic brain injuries. The DOD/VA guidelines especially caution its use with patients suffering from combat related PTSD because more than half of such patients abuse alcohol or drugs. Once initiated, benzodiazepines can be very difficult, if not impossible, to discontinue due to significant withdrawal symptoms compounded by the underlying PTSD symptoms. Most of the VA prescriptions for benzodiazepines for PTSD patients are made by mental health providers rather than primary care physicians, who should be more aware of the VA/DOD guidelines, according to a study published March in the journal Psychiatric Services. The study analyzed VA prescription records from 2009 of 357,000 veterans with PTSD. Findings also suggested that these particular providers contribute considerably to the misalignment between guideline based care and actual practice. This study did not determine the causes of such misalignment but offered a few possible reasons. Many mental health providers inherit patients who previously received benzodiazepines from other clinicians, creating an immediate tension as the clinician seeks to balance individual patient factors with the need to provide guideline supported care. Further studies are needed to determine whether the high prescription rates for benzodiazepine are due to ignorance. The majority of PTSD patients in the study were Vietnam War era veterans who perhaps began taking benzodiazepines years before guidelines were in place. Newer studies involving Iraq and Afghanistan veterans are in the works. For any concerns, contact a VA Regional Medical Center or personal physician.