Singer Nathan Leone explained this song to Kerrang! April 4, 2009: "There are a lot of temptations that tug at you in this world: girls, drugs, going out partying. There are things you aren't meant to do, but there seems to be a devil on your shoulder telling you to do them. This song is about that guy coming out at night when you're restless and you feel like you haven't done enough living, Sid and Nancy style!"
Fall Out Boy's "The Kids Aren't Alright" song title is not a reference to The Offspring's 1998 single of the same name. It actually alludes to The Who's 1979 rockumentary film called The Kids Are Alright.