One idea as to why AA works

I think it's very difficult effectively therapize in the addiction field without addressing spirituality. 

In my lectures at The Meadows I frequently ask patients why they think AA works. First they come up with some answers, then I tell them my theory;"It's because the two guys who put AA together were alcoholics themselves and they realized that booze had become their higher power. Steps two and three in AA aren't about finding God, they're about realizing that booze has been the god we followed, and since that's obviously not working maybe we should try something else." This can be a really effective lesson for many addicts, especially those who grew up in spiritually abusive settings and as such are struggling with the whole "higher power" thing in the 12-steps.

This example is particularly interesting when you compare an active, long-term addict with a religious zealot. Both adapt every element of thier day-to-day life so that it serves what they believe in. Generally both prefer to keep the company of like-minded friends.  And of course, both are willing to face horrific consequences, sometimes even including a gruesome death, rather than challenge their commitment to what they believe in. 

Ultimately the addict is, by my way of thinking, one who has built a religion out of thier substance or behavior.  That's part of why statistics on addiction are so mind-bogglingly poor - recovery is a tough sell.  Think of how rarely human beings are willing to reexamine their deepest and most treasured beliefs - it doesn't come up often.  When it does come up, think of how rarely any of us is willing to walk through the unbelievable pain of restructuring our worldview from the bottom up...