The video was dedicated to bassist Mike Inez's dog Chuck, who appeared in the video and died soon after the shooting.
The song was written by guitarist/vocalist Jerry Cantrell to his girlfriend of seven years, Courtney Clarke. In the liner notes of Alice in Chains 1999's box set 'Music Bank', Cantrell wrote about the song: "["Down in a Hole"]'s in my top three, personally. It's to my long-time love. It's the reality of my life, the path I've chosen and in a weird way it kind of foretold where we are right now. It's hard for us to both understand... that this life is not conducive to much success with long-term relationships."
The video was shot in Johanesburg, California in just one day (August 9, 1993). Most of the video was shot in a trailer belonging to a man whose nickname was "Cowboy Frank Without A Horse".
Jerry Cantrell revealed during an interview on SiriusXM's Lithium on August 21, 2018 that the music video for "Down In a Hole" is one of his favorite videos that the band has ever made.