Almost Lost tells the story of Sammy, a runaway teenager who dabbles in rap, the occult, and drugs, and is turned into a happy, wholesome teen by attending therapy with Sparks.

Patrick Jones wrote in A Core Collection for Young Adults that Almost Lost is about hope as Sammy manages to leave his "hard life through peace, love, and understanding.

Sandra Doggett from the School Library Journal stated that, "It is hard to imagine that the troubled teenager described in the beginning could change so dramatically so quickly and cure his father's cocaine habit, recover from depression, and restore his parents' marriage.

[3] A reviewer from Publishers Weekly was more positive, stating that Sammy "can be almost astonishingly articulate" as he discloses traumatic incidents from his past.

The reviewer felt that "the transcripts shape a clearly defined portrait of an intelligent, determined teen", though some of the patient-therapist conversations "may seem lengthy and repetitious to the general YA reader.