Thus song is about colsons public use of cocaine and other substances. He has been very open about his problem in drugs and was going through a very rough time in 2019 using drugs to cope. In this song he references a lot of the things that happened making him spiral into this. Ironically, the music video for 53:666 he is led on the bottom of a spiral staircase, solidating my point. He talks about being up at 5:3666 in the morning and smoking something but describing this thing as a woman. I think he chose to describe it as a woman to try and humanise it.