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As many as a dozen masked men armed with automatic weapons stormed into a drug rehabilitation center in this violent border city on Wednesday night, lined up recovering drug addicts and alcoholics against a wall and opened fire at point-blank range, killing 18 people.

The attack, within sight of the border with the United States, was a shocking new low in the wave of vicious crimes Mexico has endured since President Felipe Calderon began a frontal assault on the nation’s drug gangs in December 2006. Rehab clinics have been a special target in Juarez, with cartels hunting for rivals who might be hiding in the clinics or recruiting in them.

After investigators had removed the bodies early Thursday morning and rushed the few survivors to the hospital, relatives of the victims at the Aliviane rehab center pushed inside. A thick layer of blood covered the concrete floor, from the entrance to the courtyard to the sleeping quarters. A chained dog had been shot, while another huddled in a corner, unhurt. The smell of death hung in the air.

“It’s horrible,” wailed a woman whose son had been a patient at the clinic. She clutched a telephone pole for support after stumbling away. “My God,” she said. “My son is dead.”

The upsurge of violence in Juarez, where rival gangs have been battling for the lucrative smuggling route to the United States, seems an open challenge to Calderon’s government, which has sent 10,000 troops and federal police officers to patrol the streets and retake control of the city from the traffickers.

Despite the reinforcements, Jua-rez experienced the most violent month in its history in August, according to the local media, with at least 326 killings. That was almost half the homicides in all of Mexico for the month. And Juarez, Mexico’s most violent city in 2008 with 1,600 killings, is on pace to exceed that figure this year.

In Michoacan, a center of drug violence west of Mexico City, the deputy director of public safety, Jose Manuel Revuelta, was shot to death on Wednesday, along with two bodyguards. He had been on the job for less than two weeks.

In the past two years, gunmen suspected of ties with drug gangs have barged into rehab clinics in Juarez four times and started shooting. The death toll from these attacks on clinics is about 30.

Juan Manuel Vega, who has run a treatment center for years in Juarez, says drug users find it very hard to change their ways. “Everything about your life has to change,” he said. “And there are people who don’t want you to change.”