In my experience, Adderall does lose effectiveness but Vyvanse is much hardier. I’ve been receiving treatment for ADHD for about 4 years. My current Vyvanse dose is marginally higher than my original Adderall dose, but I’m considering reducing it down to below my original Adderall dose.
Cognitive behavioral therapy does excel at treating ADHD! But 5 years of therapy is what, 16 times more expensive than 5 years of medication? Maybe more? Not to mention the time commitment.