In this paper, we assess how resettlement and changes in water access have altered livelihoods of local communities upstream of the Theun Hinboun Expansion Project in Lao PDR. Based on household surveys conducted both before and after resettlement, we estimate changes in water use and benefits among households of 4 resettled villages. Results show that access to domestic water supply as well as water consumption have significantly improved after resettlement, while river-based livelihoods have for the most part been adversely impacted by the conversion of the Nam Gnouang River into a hydropower dam reservoir, and subsequent loss of riverbank gardens and the overall change in the ecosystem. In particular, the sources of income have become concentrated to much fewer options than before resettlement, with some households more specialized in fisheries than others. Our results represent a transitional state of economic activities by rural communities immediately after resettlement, rather than a fully evolved livelihood portfolio in a new environment. The results also suggest that a better understanding of changes in water use and benefits and of the determinants of adaptation is needed to better design appropriate interventions for rebuilding local livelihoods.