The entirety of A Million Little Pieces is told through James Frey’s point of view and is strictly limited to his thoughts, emotions, and reactions. James’s troubles begin roughly a decade before the beginning of the novel. James was a privileged child who grew up feeling like an outcast, despite the fact that his family was well-off and fairly stable. He claims he began drinking and smoking pot at age ten. Now, at age twenty-three, his addictions have spun wildly out of control. He is using alcohol and drugs in lethal quantities, is wanted in several states, and is blacking out constantly. When we first encounter him, he is on a plane but has no idea where he is going. He is bloody and his teeth are broken, but he has no idea what caused his injuries. His parents are waiting for him when he lands, and they take him to a world-renowned rehabilitation clinic, where the majority of the story takes place.

James has problems following rules. This extends from his behavior in the clinic to the style of his writing itself. He uses no quotation marks, relying instead on paragraph breaks to denote who’s speaking, even in conversations with multiple characters. His sentences are terse, and he sometimes fills entire pages with single-sentence paragraphs. He capitalizes about half of his nouns. Only a scribbled line marks the major sections of the book. As a patient, he rejects the Twelve Step program, the entire basis of the treatment. He rejects assistance at almost every turn. He violates a major rule and begins a relationship with a female patient named Lilly. The clinic staff members despair of James and tell him that if he doesn’t follow their treatment plan, he is almost guaranteed to relapse. It is understood that a relapse will likely kill him.

At first, James just seems difficult and self-centered. In time, though, his stubbornness turns into resolve, and he becomes determined to get sober. He becomes part of a group of friends that come from all walks of life and transcend all social and economic barriers, including a judge, the former Featherweight Champion of the World, a mobster, and a steelworker. He learns to accept help from other people and also how to support others. When Lilly is in trouble, James puts everything on the line to save her. In the Tao Te Ching, he finds a philosophy that compliments his worldview and makes the book the basis of his personal recovery plan. In the end, using his own willpower, James triumphs over his addiction.