Many times it begins with psychological help then moves into the spiritual realm.
A friend has spent a lifetime working with alcoholics and drug users. He first concentrates on the psychological help then introduces them to the spiritual help of the gospel.
He has much better success using that method than any other.
The addicts usually reject the spiritual until the psychological is at least partly dealt with.
Unfortunately, with the psychiatric profession falling to “fake science” and acceptance of sexual dysfunction and body/gender dysmorphic disorder as “normal”, fewer and fewer will be willing to truly treat it (rather than send them on to a butcher willing to turn them into whatever they “feel” that they are).