$addToSet do not add the item to the given field if it already contains it, on the other hand $push will add the given object to field whether it exists or not.
{_id: "docId", items: [1, 2]}
db.items.update({_id:"docId"}, {$addToSet:{items: 2}}); // This won't update the document as it already contains 2
db.items.update({_id:"docId"}, {$push: {items:2}}); // this will update the document. new document {_id: "docId", items:[1,2,2]}