He graduated from St Johnsbury Academy in 1898, having met his future wife Anne Robinson Ripley at a dance there.

After graduation in 1902, he worked for three years selling hardware in Boston, Chicago, and Montreal and continued drinking heavily.

He transferred to Rush Medical College, but his alcoholism worsened to the point that his father was summoned to try to halt his downward trajectory.

He married Anne Robinson Ripley on January 25, 1915, and opened up his own office in Akron, Ohio, specializing in colorectal surgery and returned to heavy drinking.

He was encouraged by the passage of Prohibition in 1919, but soon discovered that the exemption for medicinal alcohol, and bootleggers, could supply more than enough to continue his excessive drinking.

For the next two years Smith attended local meetings of the group in an effort to solve his alcoholism, but recovery eluded him until he met Bill Wilson on May 12, 1935.

Recognizing the danger, he made inquiries about any local alcoholics he could talk to and was referred to Smith by Henrietta Seiberling, one of the leaders of the Akron Oxford Group.