Unlike in previous generations, hardly any formal organizations are pushing to reduce the amount that Americans drink. Some groups oppose marijuana (by many measures a much safer drug than alcohol), guns, porn, junk food, and virtually every other vice. Still, the main U.S. organizations I could track down that are by any definition anti-alcohol are Mothers Against Drunk Driving—which mainly focuses on just that—and a small nonprofit in California called Alcohol Justice. In a country where there is an interest group for everything, one of the biggest public-health threats is largely allowed a free pass. And there are deep historical and commercial reasons why.

Americans would be justified in treating alcohol with the same wariness they have toward other drugs. Beyond how it tastes and feels, there’s very little good to say about the health impacts of booze. The idea that a glass or two of red wine a day is healthy is now considered dubious. At best, slight heart-health benefits are associated with moderate drinking, and most health experts say you shouldn’t start drinking for the health benefits if you don’t drink already. As one major study recently put it, “Our results show that the safest level of drinking is none.”

Read: Teaching sobriety with ‘the bottle’

Alcohol’s byproducts wreak havoc on the cells, raising the risk of liver disease, heart failure, dementia, seven types of cancer, and fetal alcohol syndrome. Just this month, researchers reported that the number of alcohol-related deaths in the United States more than doubled in two decades, going up to 73,000 in 2017. As the journalist Stephanie Mencimer wrote in a 2018 Mother Jones article, alcohol-related breast cancer kills more than twice as many American women as drunk drivers do. Many people drink to relax, but it turns out that booze isn’t even very good at that. It seems to have a boomerang effect on anxiety, soothing it at first but bringing it roaring back later.

Despite these grim statistics, Americans embrace and encourage drinking far more than they do similar vices. Alcohol is the one drug almost universally accepted at social gatherings that routinely kills people. Cigarette smoking remains responsible for the deaths of nearly 500,000 Americans each year, but the number of smokers has been dropping for decades. And few companies could legally stock a work happy hour with joints and bongs, which have never caused a lethal overdose, but many bosses ply their workers with alcohol, which can be poisonous in large quantities.

America arrived at this point in part because the end of Prohibition took the wind out of the sails of temperance groups. When the nation’s 13-year ban on alcohol ended in 1933, alcohol control was left up to states and municipalities to regulate. (This is why there are now dry counties and states where you can’t buy alcohol in grocery stores.) At the national level, anti-alcohol efforts were “tainted with an aura of failure,” writes the wine historian Rod Phillips in Alcohol: A History. Membership in the Woman’s Christian Temperance Union, the original prohibitionist group, declined from more than 2 million in 1920 to fewer than half a million in 1940. Some Christian groups continued to push for restrictions on things such as liquor advertising throughout the ’40s and ’50s. But eventually alcohol dropped off as a major national political issue and was eclipsed by President Richard Nixon’s war on drugs such as marijuana and heroin.