As he checks into the rehab clinic, he is forced to quit his substance abuse, a transition that later probably saves his life, whilst also an agonizing process.

[Note 1] 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 brother, despite his strong desire not to.

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 female drug addict with whom he falls in love, despite strict rules forbidding contact between men and women at the clinic.

For example, critic Julian Keeling,[3] a recovering addict, stated that "Frey's stylistic tactics are irritating...none of this makes the reader feel well-disposed towards him".

[6] Poet and author John Dolan of The eXile roundly criticized the book, saying: Frey sums up his entire life in one sentence from p. 351 of this 382-page memoir: "I took money from my parents and I spent it on drugs."

The book garnered international attention in January 2006 after it was reported that it contained fabrications and was not, as originally represented by the author and publisher, a completely factual memoir.

Stories surfaced about Random House, publisher of A Million Little Pieces, deciding to give full refunds to anyone who had purchased the book directly through it.

[11] However, on January 26, 2006, Frey once again appeared on The Oprah Winfrey Show and this time admitted that the same "demons" that had made him turn to alcohol and other drugs had also driven him to fabricate crucial portions of his "memoir", it first having been shopped as being a novel but declined by many, including Random House itself.

[14] The New York Times columnist Maureen Dowd wrote, "It was a huge relief, after our long national slide into untruth and no consequences, into swiftboating and swift bucks, into W.'s delusion and denial, to see the Empress of Empathy icily hold someone accountable for lying",[15] and The Washington Post's Richard Cohen was so impressed by the confrontation that he crowned Winfrey "Mensch of the Year".

[16][17] On January 13, 2006, Steven Levitt, co-author of the book Freakonomics, stated in his blog that, having searched the Centers for Disease Control and Prevention database of mortality detail records, he was unable to identify a single death that reasonably closely matched Frey's description of the circumstances of the death of "Lilly", Frey's alleged girlfriend in the book.

They released a statement noting, "When the Smoking Gun report appeared, our first response, given that we were still learning the facts of the matter, was to support our author.

According to the source at the company, there had been some disagreement among editors at the publishing house about Mr. Frey's authenticity, but the early dissenters had been silenced by the book's commercial success, both pre- and post-Oprah.

It stated that future editions of the book would contain notes from both the publisher and Frey on the text, as well as prominent notations on the cover and on their website about the additions.

[...] My mistake [...] is writing about the person I created in my mind to help me cope, and not the person who went through the experience.Frey admitted that he had literary reasons for his fabrications as well: I wanted the stories in the book to ebb and flow, to have dramatic arcs, to have the tension that all great stories require.Nevertheless, he defended the right of memoirists to draw upon their memories, not simply upon documented facts, in creating their memoirs.

On January 18, 2006, Marty Angelo, prison minister and author of the book Once Life Matters: A New Beginning, came to the defense of James Frey in a press release.

Talese was unapologetic about publishing Frey's A Million Little Pieces and commented the book has great value for anyone who must deal with a loved one who is an addict.

[26] In 2017, Anthony Bourdain described the book as "such an obvious, transparent, steaming heap of falsehood from the first page that I was enraged that anyone on earth would believe a word.