ADHD

It is my understanding that stims have two effects:

They work a bit like a recreational stim in that they make you alert, awake (or calm, with some types of ADHD) and euphoric. This effect can very much help with symptoms, e. g. in a euphoric state, it's easy to get on a task. This effect fades over time, very much like caffeine or a recreational stimulant drug.

But they also regulate noradrenaline and dopamine in the prefrontal cortex in other ways which may not directly lead to a heightened state nor effect the vegetative system, but help with many ADHD symptoms. This effect does not fade, possibly not even a little bit!

For the patient, it's hard to distinguish, and a patient may even "mistake" the "recreational high" for all it does, but it's actually kind of a side effect. I believe that this is where the notion of "needing a break" comes from.

The docs & society kind of wants us only to have the 2nd therapeutic effect anyway, and they only grudgingly tolerate that we might also get the high for a while, because we are not supposed to have good things.

As someone who takes a non stimulant(atomoxetine), I can go for half a day not realising I forgot to take it but once I do realise it becomes pretty obvious why I'm doing the things I'm doing.

You might build a tolerance to feeling some of the effects but the drugs never truly stop having some sort of effect.

You build a tolerance but it never necessarily stops working if you use it correctly to help you build the compensatory systems that will help you manage things on or off meds

You have to build systems with or without the meds. Meds help you reinforce and ingrain those systems but you still have to be deliberate in practicing them.

There's no point titrating beyond like 30mg of dex or whatever the equivalent is for whatever methylphenidate/amphetamine med you're taking.

Almost undoubtedly, the ones taking more than that are overly relying on their drs to provide solutions only their working on developing these systems along with meds can provide. So many people on r/ADHD come across this way, they almost all seem like very newb ADHD people and they completely betray that about themselves with their recommendations and focus on titration and getting a higer dose and loudly declaring to everyone you're ADHD. Often (unknowingly) they are chasing the initial euphoria which will never be a thing in the same way after a few weeks of continuous use which everyone eventually falls into.

Drs can provide the meds that can help you learn to manage and live, the meds cannot make you manage by itself if there's no self-work on setting up systems to compensate for the deficiencies

I've been taking 70mg Vyvanse (and now the generic) for years. I've built up a tolerance somewhat but I can absolutely tell whether I've taken it. It's still mostly effective for about 12 hours, depending on what I've eaten that day.

Some people like to take stimulant breaks. That's not an option for me. I've tried several times and it's not worth it to me. I'm still happy with its performance overall.

Main problem I'm having right now is getting my motor tics under control. 6 mg Guanfacine ER (which is a lot) works but makes me feel exhausted all day. 5 mg is better but not perfect. May just have to settle with "good enough" on that.

Was on Ritalin in the 90s. Helped my focus, but also made me uncontrollably angry at everything and I would lash out at myself and things around me. Was on it from 11 to 16. I think I would like to do that time over again and just have poor focus.