This in-depth conversation between Dr. Mark Gold and Dr. David Smith explores the origins, evolution, and current challenges of addiction medicine in the United States. Dr. Smith, a pioneer in the field, recounts his groundbreaking work starting in 1967 with the founding of the Haight Ashbury Free Clinic during the “Summer of Love” in San Francisco.

He narrates the shift in societal and medical perspectives on addiction—from a criminal issue to a recognized medical specialty—and highlights the clinic’s innovative approach integrating medical, psychiatric, and addiction treatments.

The discussion covers key historical milestones such as federal funding triggered by the Vietnam War, the emergence of methamphetamine and cannabis addiction, the adoption of clinical toxicology and drug testing protocols, and the impact of workplace safety initiatives like the Exxon Valdez case.

Dr. Smith also addresses the complexities of substance use in contemporary society, emphasizing the potency and dangers of modern cannabis, the opioid epidemic, and the evolving role of harm reduction versus recovery-oriented care. The conversation touches on the re-emergence of psychedelic research with cautious optimism, the importance of 12-step programs in recovery, and the challenges addiction medicine faces amid political and social backlash.

The interview closes with a recognition of the continuing need for education, compassion, and scientifically grounded treatment to improve outcomes for individuals and communities struggling with addiction.