Close friend overdosing on Tylenol PM for 2 years, how to help?

First of all, I'm a nurse and let me tell you that acetaminophen (Tylenol) poisoning is a terribly painful, slow, horrifying death. Beyond it being absurd that she is taking THAT much medication to help her sleep, she's literally killing herself. The liver is a very finely-tuned organ - however, acetaminophen CAN build up and be stored in the liver for several days at a time. If she is taking that much Tylenol, it may not necessarily hurt her IMMEDIATELY, but it could build up to a toxic level VERY quickly and she will overdose. There are not many things that can successfully reverse an acetaminophen overdose - in other words, sadly and unfortunately, if she does accidentally overdose on it, the toxicity can not be stopped and if she does not die from it, there are tremendous side effects like brain damage causing her to be "vegetable". With "addictions" like this, it is not always necessary to obtain rehab - if she can not sleep, Tylenol PM is NOT going to be enough - no matter HOW much she is taking. She probably needs prescription medication to help her sleep. There ARE OTC medications that have the same ingredient in Tylenol PM for sleep that have NO Tylenol in them (Nytol, Unisom, etc and several generic versions.) Taking them will have the same effect as Tylenol PM without the damaging effects of acetaminophen. I would suggest she speak to her doctor and probably seek help through a counselor - there's more going on than just having trouble sleeping. She should also see a gastroenterologist - if she's vomiting, her body is most likely forcing a TOXIC amount of medication out, but acetaminophen is terribly damaging to the stomach and taking that much has probably given her ulcers as well. And you'd actually he surprised how common "dependencies" like these occur. It's not as rare as you seem to believe, and there is definitely help available. Like I said though, rehab probably isn't going to be necessary if she can switch to a safer, more effective, less toxic medication - but if she can't do it or is resistant, she may need more formal istance. Hope that helps!