Lots of good points so far.
A couple of things I want to mention.
my hangovers have morphed into something horrible. Extreme anxiety and self hatred, shakes, and constant vomiting, night sweats, are the new after effects of a single night of drinking
It sounds like physically you've crossed the line. Alcoholism is progressive, your hangovers are only going to get worse. That's what happened to me. Then I came up with the brilliant idea of drinking a couple of beers in the morning to ease the hangover. I bet you can guess how well that worked out.
You need to stop drinking before you start losing stuff, like your wife, daily contact with your children, your self esteem and everything else you care about. If alcohol is your #1 priority, everything else comes in second place. Eventually, it could just be you and the bottle.
And your wife knows that you drank last night, she is just unsure how to confront you about it. Women have this intuition thing that drunk guys aren't going to pick up on.