Epidemiological research on drugs : reflections on what it means to be a drug epidemiologist

FRANÇAIS :
Cet article replace la recherche épidémiologique en toxicomanie dans un large contexte incluant les tendances essentielles du phénomène, les tensions importantes existantes dans l'élaboration des politiques en matière de drogue et, enfin, les changements sociaux, économiques et politiques qui s'opèrent en Europe. La prise en considération de tout cela fait ressortir des questions primordiales à propos du rôle et des priorités de l'épidémiologie. L'article se poursuit en mettant en avant le concept de "paradigme", essentiel en ce qu'il se réfère aux hypothèses sous-jacentes élaborées pour définir le phénomène, analyser "l'explication" elle-même, et enfin décider du fondement de telle ou telle hypothèse. Ce faisant, on arrive alors dans le champ de la philosophie de la science, et par conséquent à la relation entre la connaissance et l'action. Développer toutes ces questions amène à soulever des aspects essentiels de la recherche épidémiologique en toxicomanie sur les années passées.
ENGLISH :
This paper starts by standing back to place the activity of epidemiological research on drugs in the broader context within it is pursued. That wider context includes key trends in the drug phenomenon itself, important tensions in the development of drug policies, and wider social, economic and political changes that are taking place in Europe. This broader context raises major issuess for the role and priorities of epidemiology. The paper goes on to look at what this activity called "epidemiological research on drugs" is about, at the purposes it serves and at its underlying paradigm(s). The concept of "paradigm" is central, since it refers to the underlying assumptions about how the phenomenon is to be characterized, about how "explanation" itself is to be construed, and about what sort of evidence can be accepted as valid. This takes us into the philosophy of science, and thence to the relationship between knowledge and action, since the paradigm(s) employed are closely bound up with how policies are framed and thus have far-reaching though often unrecognized implications for the actions that are taken. Only some of the implications of this approach are taken up in this paper. The process of developing these analyses poses several key aspects of epidemiological research on drugs over recent years. These are discussed as they arise. (Author's abstract)