The lyrics to each song, written by the band's then drummer Mike Portnoy, deal with his experience of alcoholism. Each song represents a certain number of the Twelve Steps. Various lyrical and musical themes run through the Suite. It was written by the band with the intention of eventually playing it live as one piece.
Portnoy went through periods of taking other drugs, including marijuana, prescription drugs and cocaine, though he considered alcohol to be his "drug of choice". Bandmate James LaBrie noted that Portnoy was "drinking like a fish"; his drinking had become a source of tension within the band. Portnoy consumed his final alcoholic drink on April 20, 2000 after the final show on Dream Theater's Scenes from a Memory tour. He found the Alcoholics Anonymoustwelve-step program (which he considers to have "saved his life"), and makes it a priority to attend meetings while touring.