When A Million Little Pieces was published, the memoir was praised by critics for its brutally honest depiction of addiction and rehabilitation. In a review in the San Francisco Chronicle, James Sullivan wrote, "James Frey's staggering recovery memoir, A Million Little Pieces, could well be seen as the final word on the topic [of addiction]." Julian Keeling, a former patient at Hazelden (the setting of Frey's book) commented, "His intense, repetitive prose accurately captures the physical experience of being in recovery."

Critics also noted Frey's distinctive style and generally had praise for its effect. David Kamp of the New York Times Book Review noted, "From the get-go, his book sets itself apart, its narrative unspooling in short, unindented paragraphs and barely punctuated sentences whose spare, deadpan language belies the horror of what he's describing—a meltdown dispatched in telegrams." John Freeman of the Boston Globe called...