Hacking Your ADHD
Episode: Research Recap – Discontinued Use of ADHD Meds
Host: William Curb
Guest: Sky Waterson
Date: January 30, 2026
Episode Overview
In this Research Recap episode, host William Curb and guest Sky Waterson dive into the findings of a systematic literature review titled Adherence, Persistence and Medication Discontinuation in Patients with Attention Deficit Hyperactivity Disorder. The study explores real-world patterns of adherence to ADHD medication, uncovering the high rates at which patients discontinue use, the reasons behind these trends, and the clinical and social factors influencing medication persistence.
Main Discussion Points & Insights
1. Stunning Statistics on Medication Adherence
[02:15 – 03:33]
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The majority of patients do not remain on their ADHD medications long-term.
- Only about 25% of patients continue ADHD meds after 1–3 years.
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Over half stop adhering to guidelines or discontinue treatment within 2 to 3 years.
"What they found was that a majority of people don't adhere to their treatment regimes... only 25% of people stayed on medication."
— William Curb [02:15] -
Comparisons between children and adults were made, but most studies focused on children due to easier study logistics.
2. Study Methods and Paper Background
[03:33 – 04:52]
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Meta-analysis covered 1,300 papers, narrowing down to 127 relevant studies (from 1990–2013).
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Strong representation of children-focused studies but included important adult studies as well.
"Most of those papers were in adherence in children, which makes sense. A lot of papers with ADHD are in children because it's easier to do those kinds of studies."
— Sky Waterson [04:27] -
Noted most paper authors were funded by ADHD medication manufacturers (Sinclair Group)—acknowledged, but hosts focused on practical implications rather than industry bias.
3. Reasons for Discontinuation and Nonadherence
[05:49 – 07:38]
Main Factors:
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Lack of Personal Motivation:
Many adults begin medication due to external pressure (from family or work), not self-initiative, impacting long-term commitment."If you don't want to do it yourself... problems kind of go away on their own if people are like, well, that's just how things are."
— William Curb [05:49] -
Side Effects and Ineffective Symptom Control:
- Adverse effects cited in 30/41 studies.
- Perceived lack of symptom improvement cited in 27/41 studies.
- Paper did not specify which side effects were most problematic.
"One of the most common reasons that people discontinued... was that they considered adverse effects... and then ineffective symptom control."
— Sky Waterson [06:08] -
Improper Dosage/Titration Issues:
- Start-of-treatment period critical for establishing correct dose—improper titration leads to uncomfortable side effects and higher dropout.
"Often they're not on the proper dosage and so they're going to be feeling these side effects."
— William Curb [07:08]
4. The “Drug Holiday” Controversy
[08:06 – 12:05]
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Some physicians recommend periodic breaks (“drug holidays”), but:
- Not supported by ADHD organizations.
- Can worsen real-world issues and skew adherence data.
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ADHD’s impact is broad—medication helps with more than just productivity; it enhances quality of life at work and home.
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Medication breaks complicate research (e.g., refills drop in summer, but is that true discontinuation?).
"Unless you have really bad side effects, in which case you should be taking a different medication. Yeah, you should be taking your medication very regularly because ADHD affects you in all aspects of your life..."
— William Curb [08:10]"Is part of the non adherence coming from the way the medication is being talked about even by the doctor in the room?"
— Sky Waterson [09:25] -
Compared to other conditions (schizophrenia, bipolar), there’s no expectation to routinely take time off meds.
5. Social Stigma and System Barriers
[10:21 – 14:48]
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Social stigma is both a direct and indirect driver of discontinuation (patients, parents, even medical professionals).
- Medication can be perceived as only for “work” or productivity.
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Systemic/Administrative Barriers:
- Refilling prescriptions can be difficult due to logistics, moving, bureaucracy, and pharmacy shortages.
- Some patients keep legacy doctors even after moving to avoid obstacles.
"Sometimes there's no medication where they are, so they have to ring around... Sometimes systems lapse or psychiatrists leave..."
— Sky Waterson [14:01]"I'll just drive the extra 45 minutes to get to him because... I'm about what I'm worried about could happen."
— William Curb [14:48] -
Notable: Cost was at the bottom of the list of reported reasons for discontinuation; logistical and stigma-related issues were more prominent.
6. Expert vs. Patient Perspectives on Nonadherence
[15:15 – 16:52]
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Expert Opinion: Dosing, inconvenience, and social stigma are the top reasons (per doctors).
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Patient Reporting: More likely to claim side effects as a reason, possibly due to discomfort discussing social stigma.
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Research Difficulty: Hard to study because stigma affects willingness to self-report true motivations.
"There's either a miscommunication or maybe people don't feel comfortable sharing that social stigma is the real reason..."
— Sky Waterson [15:15]
7. Demographic Shifts and Changing Adherence Patterns
[16:56 – 17:25]
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Rising Adult Diagnoses: More women self-seeking diagnosis and medication—resulting in higher adherence rates.
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**Self-driven treatment leads to better persistence compared to external pressure.
"There's an interesting switch... because of the large group of women who are now being diagnosed and getting medicated because they want it. And so... seeing more people adhering..."
— William Curb [16:56]
Practical Takeaways and Recommendations
[17:25 – 18:24]
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Seek out support and resources if you’re struggling with treatment logistics.
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Prioritize ease of medication access and proper titration to minimize side effects.
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If wavering on medication, examine whether external pressures or social stigma are influencing your decisions.
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Medication should support all aspects of life—not just productivity.
"When you take medication, you want it to be easy to get through and you want to have as few side effects as possible with the highest magnitude effect as possible."
— William Curb [18:00]
Notable Quotes & Memorable Moments
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"One time he ran into a parking lot and almost got hit by a car. There are side effects to not taking medication too."
— William Curb [11:49] -
"You should only be on it in order to get work done for other people. Which again, this is a problem that I have..."
— Sky Waterson [10:39] -
"Interestingly, one of the least affected things was cost of the medication, which was an interesting... Like that was not in the top 10. It was like right at the bottom of the list."
— William Curb [16:52] -
"[Medication adherence] is actually a problem across many medications."
— Sky Waterson [12:31] -
"We really want to make it... have as few side effects as possible with the highest magnitude effect as possible."
— William Curb [18:00]
Key Timestamps
- 02:15: Shocking low adherence rates revealed
- 04:27: Differences between studies on children and adults
- 05:49: Role of personal motivation in persistence
- 06:08: Major reasons for discontinuation: side effects & ineffectiveness
- 08:10: The "drug holiday" debate
- 10:21: Social stigma's role
- 12:31: Systemic/admin challenges vs. other disorders
- 14:01: Personal stories about filling prescriptions
- 15:15: Patient vs. expert perspectives
- 16:56: Demographic shifts in self-motivation and adherence
- 17:25: Support resources and practical recommendations
Resource Links:
- Original study available by request (contact Sky on Instagram @dobson2025)
- More ADHD tools: unconventionalorganization.com
Tone:
Warm, honest, and practical, blending empathy with a critical look at the systems surrounding ADHD treatment.
(Skipped introductory ads, outro promotions, and sponsor messages)