Given the costs of alcohol to society, it is important to evaluate whether local alcohol licensing decisions can mitigate the effects of alcohol misuse. Robust natural experiment evaluations of the impact of individual licensing decisions could potentially inform and improve local decision-making. We aimed to assess whether alcohol licensing decisions could be evaluated at small spatial scale by using a causal inference framework.Three natural experiments SETTING AND PARTICIPANTS: Three English local areas of 1,000 - 15,000 people each INTERVENTION AND COMPARATOR: The case study interventions were (i) the closure of a nightclub following reviews; (ii) closure of a restaurant/nightclub following reviews, and (iii) implementation of new local licensing guidance (LLG). Trends in outcomes were compared with synthetic counterfactuals created using Bayesian structural timeseries.Timeseries data were obtained on emergency department admissions, ambulance call-outs, and alcohol-related crime at the Lower or Middle Super Output geographical aggregation level.Closure of the nightclub lead to temporary 4-month reductions in anti-social behaviour (-18%; 95% Credible Interval -37%, -4%), with no change on other outcomes. Closure of the restaurant/nightclub did not lead to measurable changes in outcomes. The new licensing guidance led to small reductions in drunk and disorderly behaviour (9 of a predicted 21 events averted), and the unplanned end of the LLG coincided with an increase in domestic violence of 2 incidents per month.The impact of local alcohol policy, even at the level of individual premises, can be evaluated using a causal inference framework. Local government actions such as closure or restriction of alcohol venues and alcohol licensing may have a positive impact on health and crime in the immediate surrounding area.