Substance abuse can be its own devil, and a monster of a challenge to overcome. But for many who struggle with addiction recovery, their abuse stems from underlying psychological health problems. If you fall into this category, but don’t realize it, overcoming your struggle will be hundreds, maybe thousands of times more difficult without proper treatment.

1) Anxiety. So-called self-medication with alcohol for general and social anxiety is so common it’s treated in some circles as one of the ‘advantages’ of substance abuse. The idea of alcohol and other drugs as social lubricants easing the anxiety of normal interactions is founded on serious misunderstandings about the nature of anxiety, however, and many who indulge in substance abuse as a result of anxiety find their condition worsens with time.

2) Depression. Simple depression correlates very strongly with substance abuse, even though many substances have a depressant effect that only worsens the way sufferers feel. It’s important to realize that depression doesn’t necessarily mean feeling sad. If you’re listless, tired, and can’t seem to have real fun with anything, you might be depressed even if you’re a generally positive person.

3) Bipolar disorder. When you’re up, everything is great and consequences have no meaning. Alcohol is fun, and the problems of it can be thought about later! When you’re down, nothing has meaning, nothing gives you pleasure, and the best you can hope for is to dull the dreary pain of each day. Without treatment, bipolar disorder can and will keep you locked into the cycle of addiction—so if you suspect you might have it, get help getting a handle on it.

4) PTSD. Post-traumatic stress has a well-known history of association with substance abuse. What’s important to understand is that PTSD isn’t something only soldiers and domestic violence victims suffer; any traumatic incident, even one that you feel you’re past, can have a lasting deleterious effect on you. Many who begin their substance abuse without PTSD have it by the time they clean up, due to period of conflict, homelessness, etc.

5) Schizophrenia. Sights, sounds, and smells bombard you from sunup to sunset—not all of them real. You live each moment wondering whether what you’re seeing, hearing and feeling is real, imagined, or some blend of the two. In this condition, it’s no wonder that many turn to alcohol and other substances to take the edge off, to relax, to endure. Add in a possible genetic link between the predispositions for substance abuse and schizophrenia, and you have a serious challenge to your sobriety.

None of these problems means your fight is impossible. They just need to be addressed as part of a holistic effort to maintain sobriety.