Dr Smith studied medicine at the University of Glasgow, 1976-1983 achieving a First-Class Honours B.Sc. in Animal Developmental Biology in 1980 and subsequently graduating M.B. Ch.B. in 1983. He entered psychiatry in 1984, passing the MRCPsych examination in 1988. From 1988-1992 he held the post of Lecturer in Psychological Medicine at the University of Glasgow Medical School. He was a Consultant Psychiatrist at Gartnavel Royal Hospital in Glasgow,1992-2019, and an Honorary Clinical Senior Lecturer, University of Glasgow, since 1992 (ongoing). He specialises in the field of addiction psychiatry and is currently Chair of the Medical Council on Alcohol (UK) Education Committee. He is on the Executive Committee of the Alcohol and Drug History Society (International).

He has interests in philosophy, the arts and history in relation to psychiatry and how these three perspectives can be integrated into psychiatric training. He graduated M.D. at University of Glasgow in 2018 on the basis of his thesis exploring the medical response to alcohol problems in Scotland from 1855 to 1925. He has published a wide range of articles in the fields of alcohol and drug studies and psychiatric history. He continues to work clinically as an Addiction specialist in Stirling, Scotland having retired from his long-term post in Glasgow.