The song is one of Aerosmith's most straightforward songs about how the band overcame drug abuse and addiction, and got the "monkey off their back." In the video The Making of Pump, Steven Tyler discusses how it was one of the few songs on Pump to make use of the F word, in the line "feeding that fuckin' monkey on my back". But Tyler felt he needed to make use of the word, to be more harsh and garner more attention on the issue. He felt it would make kids' ears perk up and listen to the lyrics and message of the song, which was more effective in telling the consequences of drug use, rather than the attitude of the time which was simply "just say no".
The band performed the song heavily on the Pump Tour from 1989–1990 and also on other tours throughout the 1990s. Additionally, the band performed the song at several famous televised performances, including on Saturday Night Live on February 21, 1990 as well as at their MTV Unplugged performance on September 18, 1990.