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Pakistan's neighbor Afghanistan is already a major recipient of international aid, yet few donors appear willing to spend money on one major problem -skyrocketing heroin and opium use among Afghan men, women and children. Only a single donor stepped forward this year with money earmarked for drug treatment: the United States. And the spending translates to less than $3 per addict per year.

In our final story on the explosion of drug abuse in Afghanistan, NPR's Soraya Sarhaddi Nelson reports on the losing battle to curb addiction in the capital, Kabul.

Unidentified Woman #1: (Foreign language spoken)

SORAYA SARHADDI NELSON: Inside this living room, where only women and young children are permitted, nurse Farida Ludeen checks the blood pressure of her pale-looking patient.

Unidentified Woman #2: (Foreign language spoken)

NELSON: The 25-year-old patient, whose name is Mariam, has a long list of complaints. She says her heart is pounding. She has trouble breathing. She's nauseated. Her limbs ache.

Ludeen, who works for Kabul's lone drug treatment center for women, assures Mariam that her symptoms are normal. She says it's a fierce war Mariam's body is waging now that she's stopped smoking heroin. It's a battle the five other women who have come to this home to see the nurse are also fighting.

Ludeen gives all of the women iron tablets for their anemia and ibuprofen for the pain. She says there's little else she can do but tell them to hang tough and support each other through this time.

(Soundbite of car honking)

NELSON: En route to the next patient, Ludeen expresses her frustration. She says these women are doing well now, but that they will likely relapse.

Ms. LUDEEN: (Through translator) A one-month program is too short. We don't get good results. We need more funding so we can treat them intensively for three months. That's the only way to make sure they give it up for good.

NELSON: But little Western money is forthcoming for drug-treatment centers across Afghanistan these days. Officials say that's in part because of economy hardships plaguing donors at home, but also because Afghanistan has many burning issues when it comes to illegal drugs.

Landry Carr is the narcotics affairs officer at the U.S. embassy in Kabul.

Mr. LANDRY CARR (Narcotics Affairs Officer): A lot of people feel that the money can be better spent addressing the bigger issue of counter-narcotics, and eliminating the supply of drugs, which would then also eliminate the usage of the drugs.

NELSON: Carr says too little attention to prevention and treatment will undermine Western efforts in the long run. For example, the effort to build up Afghanistan's police force. He says that since they began testing police officers and recruits who come for training, about 17 percent have tested positive for illegal drugs.

Mr. CARR: That really puts a dent in what we can do and the amount and the quality of training that we can provide, especially since we are having to segregate some of these people before we can even start training with them to give them some sort of a detox period so they'll be fit for training.

NELSON: It's not just the lack of money that impedes drug treatment in Afghanistan. Experts say there are cultural obstacles, too. For one, many Afghans take opiates as medicine. Sometimes, they are the only drugs available. Nine-year-old Imamdad says his mother first started giving him heroin when he was 7.

IMAMDAD (Through translator): If I got sick, she'd say, here, take this. It'll make your headache or sickness go away. So I did. That's how I became an addict and started smoking it three times a day.

NELSON: Imamdad, his two younger sisters and their mother, Gol Jan, have spent the last two months getting over their heroin addiction at the Sanga Amaj center in Kabul, one of only two women's drug treatment hospitals in the country. Gol Jan is lucky. Counselors here say most women addicts in Afghanistan are not allowed by their husbands, fathers and brothers to leave the family home to seek hospital care. They must rely on weekly mobile clinics like the one that visits Mariam and her neighbors.

Afghan men have more drug-treatment options. Some three dozen clinics and hospitals across the country cater to them.

Unidentified Group: (Foreign language spoken)

NELSON: The biggest one is a rudimentary detoxification program started by U.N. agencies a few months ago, at what used to be the Russian Cultural Center in Kabul. The program draws its patients from the 1,500 addicts who hang out in this bombed-out complex shooting up or smoking heroin. U.N. officials say they started this program to curb the number of people dying here.

Unidentified Man: (Foreign language spoken)

NELSON: Like the teenager this addict at the complex is yelling about on a recent morning. He is demanding that someone come remove the body. The U.N. program, like the women's mobile clinic, is only a month long and offers symptomatic relief.

TAQIH(ph): (Foreign language spoken)

NELSON: One patient named Taqih says he and other recovering addicts in the U.N. program rub each other's limbs to help ease the intense pain caused by withdrawal. The doctors here acknowledge that the 70 patients have to help themselves because there is no one else to do it.

Soraya Sarhaddi Nelson, NPR News, Kabul.

INSKEEP: You can find an audio slide show that looks at life inside a treatment center for addicts in Kabul by going to npr.org.

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