A Million Little Pieces is a semi-fictional[1] memoir by James Frey. It tells the story of a 23-year-old alcoholic and drug abuser and how he copes with rehabilitation in a twelve steps-oriented treatment center. While initially promoted as a memoir, it was later discovered that many of the events described in the book never happened.

The badly tattered James awakens on an airplane to Chicago, with no recollection of his injuries or of how he ended up on the plane. He is met by his parents at the airport, who take him to a rehabilitation clinic. We find out that James is 23 years old, and has been an alcoholic for ten years, and a crack addict for three. He is also wanted by the police in three different states on several charges.

As he checks into the rehab clinic, he is forced to quit his substance abuse, a transition that we find out later probably saves his life, but is also an incredibly agonizing event. As part of this, he is forced to undergo a series of painful root canals, without any anesthesia because of possible negative reactions to the drugs. He copes with the pain by squeezing tennis balls until his nails crack (when challenged on this incident, specifically, during his second Oprah appearance, Frey said that it may have been "more than one" root canal procedure and may or may not have included Novocaine, as he remembers it).

The book follows Frey through the painful experiences that lead up to his eventual release from the center, including his participation in the clinic's family program with his parents, despite his strong desire not to. Throughout the novel, Frey speaks of the "Fury" he is fighting, which he sees as the cause of his desire to drink alcohol and use drugs. The "Fury" could be seen as the antagonist of the novel, because he believes that he will not be able to recover until he learns to ignore it or "kill it."

Frey meets many interesting people in the clinic, with whom he forms relationships and who play an important role in his life both during and after his time in the clinic. These people include a mafia boss who plays a vital role in his recovery (subject of Frey's subsequent book My Friend Leonard), and a woman drug addict with whom he falls in love, despite strict rules forbidding contact between men and women at the clinic. James finally recovers and never relapses. Frey makes frequent use of this stream of consciousness writing technique, which allows the reader to better understand his version of the events. Frey's unique writing style also involves his capitalizing nouns throughout the book for unclear reasons. Frey also uses heavy repetition of words throughout the text.