According to Zakk Wylde, the band "just came in here and started knocking it out. That's how you make records."
The cover art was originally of three nuns with shotguns (as seen in the advertisements handed out at Ozzfest 2006), but the artwork was deemed inappropriate and was changed to three nuns playing a game of pool. The version with shotguns was used as the cover of the Concrete Jungle single.
According to AllMusic, despite the band's change of label, "not much has changed artistically, no doubt to the relief of fans. Over the course of 13 songs, the band showcases impressive musicianship, incorporating occasional moodiness and balladic touches into its otherwise charging style of metal. The usual comparisons to Alice in Chains, Pantera, and Corrosion of Conformity are as apt as ever."
According to Blabbermouth.net, "Shot to Hell will not cause [the band] to lose fans, even with the abundance of ballads this time around. In fact, it is easier to listen to Shot to Hell in one sitting because of the song variety....Shot to Hell is probably more of what you expect with just a hint of progression."