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Most of my perspective comes from the movie so bear with me. In the movie, Leonardo tries heroin as part of his downward spiral and it really turns the movie dark. In the book, he tries heroin almost at the beginning and complains because he always thought that pot got you high. In the movie Leonardo is hitching rides on buses at the beginning and turning to nastier crimes later on. In the book Carroll is describing the best methods for purse snatching. In the movie, Leonardo hustles for tricks as one of the last signs that he's fallen from grace. In the book, Carroll complains about the gay johns who make him go to baseball games or want him to whip cats to death ("unfortunately for him I was in a cat-loving mood that day and whipped him instead"). In the movie there is a helpful friend who tries to get him off of drugs. That guy is fortunately absent in the book. In the movie there is a long sequence about the best friend with cancer. In the book, he's creeped out by the corpse but that's about it.
In essence, the movie serves up a rough-around-the-edges kid who gets into a bad situation that only gets worse. The book by contrast has Jim Carroll pure and malignant, snatching purses and shooting up without a care as to the consequences. He's a nasty little punk and he deserves most of what happens to him. This is probably why Carroll's later stuff isn't as popular. Much of what makes this book great is how repulsed and intrigued you are with the narrator. When Jim Carroll grew up, kicked the addiction and stopped being such a creep, it was great for him and anyone around him, but he lost the main voice and never replaced it with anything quite so compelling.
After you read this book you should check out with Patti Smith's early book of poetry, Please Kill Me about the New York punk scene in which Carroll featured prominently and Catholic Boy. YOu might also want to watch the movie as it isn't bad by DiCaprio standards, although pretty awful by the standards of the book.