Re: how to start - high or straight?
I think you have answered the question "How does somebody know?" when it's time for detox, as I quote you here:
"I know that I have to stop. I can't do this any longer". "I just know that I will not taper"....It seems quite clear that you know what you need to do. In terms of being high or not when you meet with a doctor, it doesn't really matter. If you're not doubled over, sweating and jumping out of your skin, they assume you are high or at least have the drug in your system. I'm sure you won't even be asked. In my opinion it's very difficult to drive or for that matter do anything except be miserable initially without the drugs anyway. So yes, try to taper, or move your appointment up - just make SURE you get to the doctor/clinic. You are taking a LOT of hydro at this point, and need to make a move asap, for the tylenol factor as well. I don't mean to scare you but you're probably getting 2-3 times the absolute max of acetometaphin acceptable and are running the risk of liver damage.
Something else to keep in mind - you have a disease at this point. An uncontrollable physical NEED for this drug. Try to quiet the "What have I done?" voices in your head right now, and just focus on getting help. Many many people from all walks of life have been and will be right where you are..Phds & CEOs right along with homeless transients. The pills don't care who you are. You sound like you have a lot going for you. A marriage and a business that have not been lost at this point. But believe me they will be gone if you don't fight this battle now, so yes - follow your instincts to get help and don't spend a minute more wondering if or why you're a drug addict. You can ponder the reasons in rehab. Now is for saving your life, ok?