Well: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent.

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

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This is the second of two articles on addiction treatment. The first can be found here.

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Media Decoder Blog: NPR Campaign Seeks the Quirky Listener

Are you a sky diving algebra teacher? A Sudoku-playing barista? NPR has a new ad campaign aimed at you.

The pilot campaign, in four cities, is intended to bring new listeners to local public radio stations, and in turn NPR’s national programs, by matching a show to even the quirkiest interests.

The three-month campaign, financed with a $750,000 grant from the Ford Foundation and developed by Baltimore agency Planit, includes billboards, as well as television spots, social media outreach and rail, print and digital ads aimed at adults 25 to 54, with at least some college education. Ads point to a Web site, interestingradio.com, where visitors can take a poll, discover shows and click through to a live stream from a local station.

The ads will run in the Dallas/Fort Worth, San Diego, Indianapolis and Orlando, Fla., markets, chosen because they offer geographic diversity, as well as stations that are strong and growing, said Emma Carrasco, who joined NPR two months ago as chief marketing officer, a new position.

The campaign comes as listenership for “Morning Edition” and “All Things Considered” — NPR’s two top programs and the radio news programs that reach the most people nationwide each week — declined from spring 2011 to spring 2012, the last period for which national ratings are available.

Year-to-year, the cumulative weekday audience for “Morning Edition” declined 5 percent to 12.3 million listeners a week, from 13 million, NPR officials said, citing Arbitron ratings figures, while “All Things Considered” was off 4 percent, to 11.8 million weekly listeners, compared with 12.3 million in spring 2011.

Preliminary fall 2012 estimates showed year-to-year audience increases for those two shows, NPR said, but the figures were for major markets only.

Local public radio stations have undertaken similar efforts in recent years. WQXR’s modest 2011 “Obeythoven” campaign used TV spots to get audiences thinking about New York City classical music radio in a new way. Chicago’s WBEZ this month began a cheeky campaign called “2032 Membership Drive” encouraging audiences to procreate and raise a new generation of listeners.

If NPR’s new ads are deemed successful, NPR will seek additional funds to expand them to more markets, Ms. Carrasco said.

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New Focus in Mali Is Finding Militants Who Have Fled Into Mountains

Tyler Hicks/The New York Times

A fish market in Konna, Mali, that had been occupied by Islamist rebels. It was the seizure of Konna, in the Mopti region, that provoked France’s military intervention last month.

DAKAR, Senegal — Just as Al Qaeda once sought refuge in the mountains of Tora Bora, the Islamist militants now on the run in Mali are hiding out in their own forbidding landscape, a rugged, rocky expanse in northeastern Mali that has become a symbol of the continued challenges facing the international effort to stabilize the Sahara.

Expelling the Islamist militants from Timbuktu and other northern Malian towns, as the French did swiftly last month, may have been the easy part of retaking Mali, say military officials, analysts and local fighters. Attention is now being focused on one of Africa’s harshest and least-known mountain ranges, the Adrar des Ifoghas.

The French military has carried out about 20 airstrikes in recent days in those mountains, including attacks on training camps and arms depots, officials said. On Thursday, a column of soldiers from Chad, versed in desert warfare, left Kidal, a diminutive, sand-blown regional capital, to penetrate deep into the Adrar, said a spokesman for the Tuareg fighters who accompanied them.

“These mountains are extremely difficult for foreign armies,” said the spokesman, Backay Ag Hamed Ahmed, of the National Movement for the Liberation of Azawad, in a telephone interview from Kidal. “The Chadians, they don’t know the routes through them.”

These areas of grottoes and rocky hills, long a retreat for Tuareg nomads from the region and more recently for extremists from Al Qaeda in the Islamic Maghreb, will be the scene of the critical next phase in the conflict. It will be the place where the Islamist militants are finally defeated or where they slip away to fight again, military analysts say.

French special forces are very likely already operating in the Adrar des Ifoghas, performing reconnaissance and perhaps preparing rescue operations for French hostages believed to be held in the area, said Gen. Jean-Claude Allard, a senior researcher at the Institute for International and Strategic Relations in Paris. But African forces are likely to be assigned the brunt of the combat operations, going “from well to well, from village to village,” General Allard said.

The few Westerners who have traveled in this inaccessible region bordering Algeria say it differs from Afghanistan in that the mountains are relatively modest in size. But its harsh conditions make it a vast natural fortress, with innumerable hide-outs.

“The terrain is vast and complicated,” said Col. Michel Goya of the French Military Academy’s Strategic Research Institute. “It will require troops to seal off the zone, and then troops for raids. This will take time.”

The number of militants who remain is in dispute, with estimates varying from a few hundred fighters to a few thousand. They are becoming more dispersed and are hiding themselves ever more effectively, Western military officials say.

The French military has been flying fewer sorties over the region in recent days, “from which I deduce a lack of targets,” said a Western military attaché in Bamako, Mali’s capital, who was not authorized to speak on the record. “They are just not finding the same targets. Clearly they are hiding better and dispersing more widely.”

A ranking Malian officer stationed in the northern town of Gao said: “We don’t know how many there are. They have learned to hide where the French can’t find them.”

The militants are versed in survival tactics in the hills, supplying themselves from the nomads who pass through and getting water from the numerous wells and ponds, said Pierre Boilley, an expert on the region from the Sorbonne. Still, the sources of water are an opportunity for the French and Chadian forces, as they can be monitored without too much difficulty, experts said.

“It’s a sort of observation tower on the whole of the Sahara,” General Allard said. The fighters have had years to build installations, modify caves, and stock food, weapons and fuel, he said, and the precise locations of their refuges remain a mystery.

Even if the bulk of the militants have retreated into the mountains, pockets remain around the liberated towns of Timbuktu and Gao, said a French military spokesman, Col. Thierry Burkhard. Last week, French forces patrolling the area around Gao engaged in firefights with militants, some of whom fired rockets, officials said.

“We’re encountering residual jihadist groups that are fighting,” said Jean-Yves Le Drian, France’s defense minister.

On Friday, a suicide bomber blew himself up at a military checkpoint in Gao, wounding a soldier, an act that provided further evidence of the continued threat of the militants.

Adam Nossiter reported from Dakar, and Peter Tinti from Gao, Mali. Eric Schmitt contributed reporting from Washington, and Scott Sayare and Steven Erlanger from Paris.

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Michigan, Kansas go down as run continues

There goes another one, and another one.

No. 3 Michigan, fifth-ranked Kansas and No. 11 Louisville all lost on Saturday, continuing a perilous stretch for the Top 25.

The Wolverines became the third top-three team to fall this week when Ben Brust hit a tiebreaking 3-pointer with less than 40 seconds left in overtime, leading Wisconsin to a 65-62 victory. Brust also tied the game at the end of regulation with a heave from just inside halfcourt.

That's just the way it has gone lately for the top of the poll.

No. 2 Florida lost at Arkansas on Tuesday night, and No. 1 Indiana dropped a 74-72 decision at Illinois on Thursday. This should be the sixth straight week with a different No. 1 in The Associated Press' Top 25, which would be the second-longest streak since the first AP poll in 1949.

The Jayhawks have dropped three straight games for the first time in eight years after they lost 72-66 at Oklahoma.

"It hasn't been a good week for us by any stretch, but let's be real," Kansas coach Bill Self said. "We were ranked No. 2 in the country seven days ago, and you don't go from being a good team to a bad team overnight.

"We've had a couple of bad outings, but we're still a good team."

The current string of No. 1 swapping is the longest since 1994, when Arkansas, North Carolina, Kansas, UCLA and Duke alternated at the top seven straight weeks — the longest streak since Saint Louis debuted as No. 1 in the initial AP poll.

But it isn't just the teams at the top that are having trouble. Top 25 teams all over the country are getting knocked off by unranked opponents.

According to STATS LLC, Top 25 teams lost to unranked teams 36 times from Jan. 17 to Feb. 6 this season, most in at least 17 years.

Louisville lost 104-101 in five overtimes at No. 25 Notre Dame on Saturday night. It was the longest regular-season game in Big East history.

The Irish trailed by eight with 46 seconds left in regulation.

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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Boeing 787 Completes Test Flight

A Boeing 787 test plane flew for more than two hours on Saturday to gather information about the problems with the batteries that led to a worldwide grounding of the new jets more than three weeks ago.

The flight was the first since the Federal Aviation Administration gave Boeing permission on Thursday to conduct in-flight tests. Federal investigators and the company are trying to determine what caused one of the new lithium-ion batteries to catch fire and how to fix the problems.

The plane took off from Boeing Field in Seattle heading mostly east and then looped around to the south before flying back past the airport to the west. It covered about 900 miles and landed at 2:51 p.m. Pacific time.

Marc R. Birtel, a Boeing spokesman, said the flight was conducted to monitor the performance of the plane’s batteries. He said the crew, which included 13 pilots and test personnel, said the flight was uneventful.

He said special equipment let the crew check status messages involving the batteries and their chargers, as well as data about battery temperature and voltage.

FlightAware, an aviation data provider, said the jet reached 36,000 feet. Its speed ranged from 435 to 626 miles per hour.

All 50 of the 787s delivered so far were grounded after a battery on one of the jets caught fire at a Boston airport on Jan. 7 and another made an emergency landing in Japan with smoke coming from the battery.

The new 787s are the most technically advanced commercial airplanes, and Boeing has a lot riding on their success. Half of the planes’ structural parts are made of lightweight carbon composites to save fuel.

Boeing also decided to switch from conventional nickel cadmium batteries to the lighter lithium-ion ones. But they are more volatile, and federal investigators said Thursday that Boeing had underestimated the risks.

The F.A.A. has set strict operating conditions on the test flights. The flights are expected to resume early this week, Mr. Birtel said.

Battery experts have said it could take weeks for Boeing to fix the problems.

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IHT Rendezvous: IHT Quick Read: Feb. 9

After a failed attempt to set spending targets at a summit meeting in November and in a 24-hour marathon of talks this week, European leaders finally agreed late Friday to a common budget for the next seven years. The new budget, which is slightly smaller than its predecessor — the first decrease in the European Union’s history — reflects the climate of austerity across a Continent still struggling to emerge from a crippling debt crisis. James Kanter and Andrew Higgins report from Brussels.

Few things divide British eating habits from those of Continental Europe as clearly as a distaste for consuming horse meat, so news that many Britons have unknowingly done so has prompted alarm among shoppers and plunged the country’s food industry into crisis. A trickle of discoveries of horse meat in hamburgers, starting in Ireland last month, has turned into a steady stream of revelations, including, on Friday, that lasagna labeled beef from one international distributor of frozen food, Findus, contained in some cases 100 percent horse meat. Stephen Castle reports from London.

The coaches of England’s Premier League are an aggressively unstylish bunch, stalking the sideline in the most scrutinized sport in the world with wardrobes that speak less of Savile Row than of the remainder rack on the Island of Misfit Clothes. The way the coaches dress, there’s no mistaking the English Premier League sideline for a fashion runway. Sarah Lyall reports from London.

With only two weeks to go before national elections, the Italian campaign has become a surreal spectacle in which a candidate many had given up for dead, former Prime Minister Silvio Berlusconi, has surged. Although he is not expected ever to govern again, with his media savvy and pie-in-the-sky offers of tax refunds, Mr. Berlusconi now trails the front-runner, Pierluigi Bersani, the leader of the Democratic Party, by about five or six points, according to a range of opinion polls published on Friday. Rachel Donadio reports from Rome.

ARTS The auction of Impressionist and Modern art followed by Surrealist works that took place at Sotheby’s on Tuesday evening ended with 52 lots fetching £121 million. It will be remembered by auction house professionals as the second most successful sale in the field held at Sotheby’s London and, by some of those attending, as the strangest session in living memory. Souren Melikian reports from New York.

SPORTS If size or the weight of history were the sole determining factors in a soccer match, then you might wonder why Burkina Faso would even bother to turn up against Nigeria in the Africa Cup final. Rob Hughes reports from London.

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Bryant leads Lakers over Bobcats 100-93

CHARLOTTE, N.C. (AP) — Even though Kobe Bryant and the Lakers were able to escape with a 100-93 win Friday night over the Charlotte Bobcats, the Los Angeles star was left feeling "irritated" after the game.

Irritated at his team's shot selection.

Irritated at his team's selfishness.

And especially irritated that the Lakers needed to overcome a 20-point deficit to beat the NBA's worst team.

"We have to play the right way," Bryant said. "When we have shots available, we take them. If we don't, move the ball on. It can't be about individual touches. It can't be about that."

Still, the Lakers won.

Bryant shrugged off a scoreless first half — he attempted only two shots — to finish with 20 points, eight assists and seven rebounds and the Lakers improved to 4-2 on their road trip heading into Sunday's game in Miami against the Heat.

Bryant didn't come out for warm-ups to start the second half.

But he was there to provide the spark the lackluster Lakers needed in the third quarter. He scored 14 of his points in the final period, including a driving layup with 40 seconds left to push the lead to five and help seal the win.

"In the second half I got in position where I could catch it and turn and shoot it a little bit," Bryant said. "They were reluctant to double team because we started knocking down some shots. I think that makes the game a lot easier."

Steve Nash and Earl Clark each had 17 points and Dwight Howard had 12 points, all in the first half, and 11 rebounds for the Lakers (24-27).

Howard played his second straight game despite nursing an injured right shoulder.

"Continuity," Howard said when asked of the Lakers offensive woes. "We have to do a better job of spreading everything out and moving and getting everybody involved. When we do that, we are pretty good."

Byron Mullens and Gerald Henderson each had 20 points for the Bobcats, who have lost six straight.

Charlotte led 71-51 in the third quarter, but the Lakers stormed back behind a 9-0 run. They cut the lead to one on a driving layup by Bryant with 6:06 left in the game and Antawn Jamison gave the Lakers their first lead with 4:46 remaining on a left-handed finger roll in the lane.

The Lakers took the lead for good at 92-91 when Jodie Meeks made a 3-pointer with 3:02 left in the game.

Lakers coach Mike D'Antoni wasn't pleased with the overall effort, but liked that his team bounced back after a 116-95 loss to the Boston Celtics the night before.

"We just got to be able to put our earplugs in, or mufflers on, or blinders on," D'Antoni said. "It's like the Kentucky Derby with horses, just get those blinders on and just get out there and run.

"We have so much stuff going on out here that every little thing is blown to bits and whether it is right or wrong or blown out of proportion it is. But, it affects us. It is a distraction. It saps energy. We got to be able to just close that out somehow."

The Lakers have been unpredictable this season, particularly on the road where they were 8-17 coming into this game.

Before Friday night's game against Charlotte, D'Antoni was asked if the Bobcats were a dangerous opponent for his team.

"We're playing, aren't we? (Then) there's a danger," D'Antoni said with a laugh. "If they play the national anthem, we're in danger."

He was right.

The Lakers started slow, looking out of sync just as they have for a good portion of the season as pick and rolls turned into turnovers and layups on the other end.

Nash had four early turnovers and Howard threw a pass across court that hit the side of the backboard.

The Lakers turned the ball over five times in the game's first eight minutes and fell behind 20-9.

Bryant missed his only two shots in the first half, his slowest start since March 31, 2012, when he went three quarters without scoring a point before beating the New Orleans Hornets on a game-winning shot.

The game was similar to earlier this season when the Bobcats led by 18 in Los Angeles only to squander the lead.

"We had them down pretty much the whole game," Bobcats guard Kemba Walker said. "You know, they made a really good run. Kobe made a lot of good plays, made the right passes and guys just made shots."

NOTES: Bobcats rookie Michael Kidd-Gilchrist returned to action Friday after missing two games with a concussion. ... At halftime Bryant had five rebounds, two assists and no points. ... The Bobcats had been one of three teams with a .500 or better record all-time against the Lakers, but fell to 8-9 with Friday night's loss.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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John E. Karlin, 1918-2013: John E. Karlin, Who Led the Way to All-Digit Dialing, Dies at 94

Courtesy of Alcatel-Lucent USA

John E. Karlin, a researcher at Bell Labs, studied ways to make the telephone easier to use.

A generation ago, when the poetry of PEnnsylvania and BUtterfield was about to give way to telephone numbers in unpoetic strings, a critical question arose: Would people be able to remember all seven digits long enough to dial them?

And when, not long afterward, the dial gave way to push buttons, new questions arose: round buttons, or square? How big should they be? Most crucially, how should they be arrayed? In a circle? A rectangle? An arc?

For decades after World War II, these questions were studied by a group of social scientists and engineers in New Jersey led by one man, a Bell Labs industrial psychologist named John E. Karlin.

By all accounts a modest man despite his variegated accomplishments (he had a doctorate in mathematical psychology, was trained in electrical engineering and had been a professional violinist), Mr. Karlin, who died on Jan. 28, at 94, was virtually unknown to the general public.

But his research, along with that of his subordinates, quietly yet emphatically defined the experience of using the telephone in the mid-20th century and afterward, from ushering in all-digit dialing to casting the shape of the keypad on touch-tone phones. And that keypad, in turn, would inform the design of a spate of other everyday objects.

It is not so much that Mr. Karlin trained midcentury Americans how to use the telephone. It is, rather, that by studying the psychological capabilities and limitations of ordinary people, he trained the telephone, then a rapidly proliferating but still fairly novel technology, to assume optimal form for use by midcentury Americans.

“He was the one who introduced the notion that behavioral sciences could answer some questions about telephone design,” Ed Israelski, an engineer who worked under Mr. Karlin at Bell Labs in the 1970s, said in a telephone interview on Wednesday.

In 2013, the 50th anniversary of the introduction of the touch-tone phone, the answers to those questions remain palpable at the press of a button. The rectangular design of the keypad, the shape of its buttons and the position of the numbers — with “1-2-3” on the top row instead of the bottom, as on a calculator — all sprang from empirical research conducted or overseen by Mr. Karlin.

The legacy of that research now extends far beyond the telephone: the keypad design Mr. Karlin shepherded into being has become the international standard on objects as diverse as A.T.M.’s, gas pumps, door locks, vending machines and medical equipment.

Mr. Karlin, associated from 1945 until his retirement in 1977 with Bell Labs, headquartered in Murray Hill, N.J., was widely considered the father of human-factors engineering in American industry.

A branch of industrial psychology that combines experimentation, engineering and product design, human-factors engineering is concerned with easing the awkward, often ill-considered marriage between man and machine. In seeking to design and improve technology based on what its users are mentally capable of, the discipline is the cognitive counterpart of ergonomics.

“Human-factors studies are different from market research and other kinds of studies in that we observe people’s behavior and record it, systematically and without bias,” Mr. Israelski said. “The hallmark of human-factors studies is they involve the actual observation of people doing things.”

Among the issues Mr. Karlin examined as the head of Bell Labs’ Human Factors Engineering department — the first department of its kind at an American company — were the optimal length for a phone cord (a study that involved gentle, successful sabotage) and the means by which rotary calls could be made efficiently after the numbers were moved from inside the finger holes, where they had nestled companionably for years, to the rim outside the dial.

John Elias Karlin was born in Johannesburg on Feb. 28, 1918, and reared nearby in Germiston, where his parents owned a grocery store and tearoom.

He earned a bachelor’s degree in philosophy, psychology and music, and a master’s degree in psychology, both from the University of Cape Town. Throughout his studies he was a violinist in the Cape Town Symphony Orchestra and the Cape Town String Quartet.

Moving to the United States, Mr. Karlin earned a Ph.D. from the University of Chicago in 1942. Afterward, he became a research associate at Harvard; he also studied electrical engineering there and at the Massachusetts Institute of Technology.

At Harvard, Mr. Karlin did research for the United States military on problems in psychoacoustics that were vital to the war effort — studying the ways, for instance, in which a bomber’s engine noise might distract its crew from their duties.

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